Provider Demographics
NPI:1427043181
Name:BURG, ANDREW E (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:E
Last Name:BURG
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:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-0001
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1040 RIVER HERITAGE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-6348
Practice Address - Country:US
Practice Address - Phone:941-917-7100
Practice Address - Fax:941-917-7142
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01585OtherBCBS
FL271440000Medicaid
FLP00180092OtherRAIL ROAD MEDICARE
FLP00712233OtherRAIL ROAD MEDICARE
FLU3778UMedicare PIN
FL271440000Medicaid
FLU3778TMedicare PIN
FLU3778VMedicare PIN
FLI20780Medicare UPIN