Provider Demographics
NPI:1497127096
Name:KEVIN S BURKEVICH LLC
Entity Type:Organization
Organization Name:KEVIN S BURKEVICH LLC
Other - Org Name:LASERPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BURKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-554-6245
Mailing Address - Street 1:220 LAKE LINK RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-1003
Mailing Address - Country:US
Mailing Address - Phone:610-554-6245
Mailing Address - Fax:
Practice Address - Street 1:106 CENTER ST
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4374
Practice Address - Country:US
Practice Address - Phone:610-554-6245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA25213208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty