Provider Demographics
NPI:1700866449
Name:BURICK, JOSEPH P (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:BURICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 S CLEVELAND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-2200
Mailing Address - Country:US
Mailing Address - Phone:330-628-2686
Mailing Address - Fax:330-628-0828
Practice Address - Street 1:754 S CLEVELAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-2200
Practice Address - Country:US
Practice Address - Phone:330-628-2686
Practice Address - Fax:330-628-0828
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-2729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1396782876OtherNPI GROUP NUMBER
OH9338635OtherMEDICARE GROUP NUMBER
OH0393720Medicaid
OH1396782876OtherNPI GROUP NUMBER
OH0393720Medicaid