Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 03968 | KY |
Y | 213ES0000X | Sports Medicine | 03968 | KY |
N | 2081S0010X | Sports Medicine | 34.011130 | OH |
N | 213ES0000X | Sports Medicine | 34.011130 | OH |
NPI | 1265790299 |
---|---|
Provider Name | Timothy Michael Burns |
First Address | Edgewood, KY 41017-3405 |
Second Address | Edgewood, KY 41017-3405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2012 |
Last Update Date | 04/08/2021 |