Provider Demographics
NPI:1063688513
Name:BURHAN, SUHAIR H (MD)
Entity Type:Individual
Prefix:
First Name:SUHAIR
Middle Name:H
Last Name:BURHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-3000
Mailing Address - Fax:
Practice Address - Street 1:7650 ZANE AVE N
Practice Address - Street 2:BROOKLYN PARK CLINIC
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3151
Practice Address - Country:US
Practice Address - Phone:612-873-6963
Practice Address - Fax:612-873-1920
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNPTAN0800178Medicare PIN