Provider Demographics
NPI:1023087814
Name:BUREN, JOHN B (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:BUREN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 FAIRVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-8013
Mailing Address - Country:US
Mailing Address - Phone:651-389-0182
Mailing Address - Fax:651-982-7677
Practice Address - Street 1:5200 FAIRVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8013
Practice Address - Country:US
Practice Address - Phone:651-389-0182
Practice Address - Fax:651-982-7677
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN772213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8428757Medicaid
WA7680BUOtherREGENCE BLUE SHIELD
MN772OtherSTATE LICENSE
WA0199631OtherSTATE WRKS COMP
WA8428757Medicaid
WA7680BUOtherREGENCE BLUE SHIELD