Provider Demographics
NPI:1285225516
Name:ENTELMED, INC.
Entity Type:Organization
Organization Name:ENTELMED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-985-2757
Mailing Address - Street 1:9844 RESEARCH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4381
Mailing Address - Country:US
Mailing Address - Phone:484-985-2757
Mailing Address - Fax:
Practice Address - Street 1:400 INDIAN RUN RD
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-1338
Practice Address - Country:US
Practice Address - Phone:484-985-2757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty