Provider Demographics
NPI:1184745143
Name:BURTCH, BRIAN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDWARD
Last Name:BURTCH
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 1:17600 DETROIT AVE APT 610
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3440
Mailing Address - Country:US
Mailing Address - Phone:216-224-1467
Mailing Address - Fax:
Practice Address - Street 1:8300 TYLER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4217
Practice Address - Country:US
Practice Address - Phone:216-266-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089302207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism