Provider Demographics
NPI:1871771212
Name:KENT R. BURRESS, DPM, LLC
Entity type:Organization
Organization Name:KENT R. BURRESS, DPM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURRESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-477-0200
Mailing Address - Street 1:1819 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-2159
Mailing Address - Country:US
Mailing Address - Phone:812-477-0200
Mailing Address - Fax:812-477-1267
Practice Address - Street 1:1819 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-2159
Practice Address - Country:US
Practice Address - Phone:812-477-0200
Practice Address - Fax:812-477-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0700515A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty