Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2003028521 | MO |
Y | 2080P0203X | Pediatric Critical Care Doctor | 2003028521 | MO |
NPI | 1235140559 |
---|---|
Provider Name | Dr. Ilyas Burny |
First Address | Columbia, MO 65205-7687 |
Second Address | Columbia, MO 65212-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 20/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208367110 | (05) | MO |
214221 | BCBS (01) | MO |
723806 | HEALTHLINK (01) | MO |
I28817 | (02) | MO |