Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 36-00-3188 | OH |
NPI | 1043250608 |
---|---|
Provider Name | Tracey R Burns |
First Address | Medina, OH 44256-8461 |
Second Address | Akron, OH 44320-1184 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 14/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000201218 | ANTHEM (01) | OH |
2383755 | (05) | OH |
2700867 | UNITED HEALTHCARE (01) | OH |
94557 | QUALCHOICE (01) | OH |
U83275 | (02) | OH |