Basic Information
| Provider Information | |||||||||
| NPI: | 1659470367 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BURBANK PODIATRY ASSCOCIATES GROUP A PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 241 W OLIVE AVE | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915021825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188485583 | ||||||||
| FaxNumber: | 8188481872 | ||||||||
| Practice Location | |||||||||
| Address1: | 241 W OLIVE AVE | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915021825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188485583 | ||||||||
| FaxNumber: | 8188481487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 06/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | KASE | ||||||||
| AuthorizedOfficialFirstName: | FRANKLIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8188485583 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.P.M | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.