Provider Demographics
NPI:1073627154
Name:BURAN, KATHLEEN ALLISON (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ALLISON
Last Name:BURAN
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 1:6322 GUNN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625
Mailing Address - Country:US
Mailing Address - Phone:813-864-3998
Mailing Address - Fax:813-864-3971
Practice Address - Street 1:6322 GUNN HIGHWAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625
Practice Address - Country:US
Practice Address - Phone:813-864-3998
Practice Address - Fax:813-864-3971
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058691207XX0005X
FLME69927207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine