Basic Information
| Provider Information | |||||||||
| NPI: | 1467568089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURCH | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9040 | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620029040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184620499 | ||||||||
| FaxNumber: | 6184621150 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 SAINT ANTHONYS WAY | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620024569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184658019 | ||||||||
| FaxNumber: | 6184635004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 12/11/2007 | ||||||||
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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 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.