Provider Demographics
NPI:1598957912
Name:BURGESS, AMELIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:L
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:AMELIA
Other - Middle Name:L
Other - Last Name:MILBANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:776 GOLDEN MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2053
Mailing Address - Country:US
Mailing Address - Phone:651-587-2263
Mailing Address - Fax:
Practice Address - Street 1:776 GOLDEN MEADOW RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2053
Practice Address - Country:US
Practice Address - Phone:515-872-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN478652083A0300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine