Provider Demographics
NPI:1255619813
Name:BURGART, EVAN M (MS, PA-C)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:M
Last Name:BURGART
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 FRANCE AVE S STE 400
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2130
Mailing Address - Country:US
Mailing Address - Phone:952-920-2070
Mailing Address - Fax:952-920-7444
Practice Address - Street 1:6363 FRANCE AVE S STE 400
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2130
Practice Address - Country:US
Practice Address - Phone:952-920-2070
Practice Address - Fax:952-920-7444
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11508363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical