Provider Demographics
NPI:1477637015
Name:BURNS, LARRY CHELSIE (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:CHELSIE
Last Name:BURNS
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 1:3174 CUSTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4000
Mailing Address - Country:US
Mailing Address - Phone:859-272-4882
Mailing Address - Fax:859-273-3916
Practice Address - Street 1:3174 CUSTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4000
Practice Address - Country:US
Practice Address - Phone:859-272-4882
Practice Address - Fax:859-273-3916
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64283286Medicaid
KY0691506Medicare ID - Type Unspecified
KY64283286Medicaid