Provider Demographics
NPI:1518045905
Name:BURNS, PATRICK I (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:I
Last Name:BURNS
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 1:455 E PIKES PEAK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3672
Mailing Address - Country:US
Mailing Address - Phone:719-633-4700
Mailing Address - Fax:719-633-4701
Practice Address - Street 1:4110 BRIARGATE PKWY STE 140
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7836
Practice Address - Country:US
Practice Address - Phone:719-364-6487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36422208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01364223Medicaid
COC14851Medicare PIN
CO01364223Medicaid