Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0205X | Pediatric Endocrinologist | 0438160 | KS |
Y | 2080P0205X | Pediatric Endocrinologist | 2014031249 | MO |
NPI | 1073596292 |
---|---|
Provider Name | Tania Susanne Burgert |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 19/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001410571 | (05) | CT |
3305267 | CIGNA (01) | CT |
H45461 | (02) |