Basic Information
| Provider Information | |||||||||
| NPI: | 1093808123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURG | ||||||||
| FirstName: | SCOTT | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 74628 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441940711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406462200 | ||||||||
| FaxNumber: | 4406462209 | ||||||||
| Practice Location | |||||||||
| Address1: | 5850 LANDERBROOK DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | MAYFIELD HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441244071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163830100 | ||||||||
| FaxNumber: | 2163836481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 06/15/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34002794B | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RR0500X | 34002794B | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.