Provider Demographics
NPI:1346205747
Name:ILGENFRITZ, BURR D (MD)
Entity Type:Individual
Prefix:
First Name:BURR
Middle Name:D
Last Name:ILGENFRITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 HOUMA BLVD
Mailing Address - Street 2:SUITE 640
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2933
Mailing Address - Country:US
Mailing Address - Phone:504-456-5120
Mailing Address - Fax:504-456-8038
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:SUITE 640
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2933
Practice Address - Country:US
Practice Address - Phone:504-456-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009016207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1104761Medicaid
B60698Medicare UPIN
5K043Medicare ID - Type UnspecifiedMEDICARE PROVIDER #