Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 23415 | AL |
N | 207RC0000X | Internist - Cardiovascular Disease | 00023415 | AL |
NPI | 1164462321 |
---|---|
Provider Name | Dr. Kenneth M Burnham |
First Address | Mobile, AL 36608-6705 |
Second Address | Mobile, AL 36608-1727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000096629 | (05) | AL |
0122395 | (05) | MS |
510-96629 | BLUE CROSS BLUE SHIELD (01) | AL |
G95134 | (02) | AL |