Provider Demographics
NPI:1770780553
Name:THILO E. BURZLAFF, M.D. P.A.
Entity type:Organization
Organization Name:THILO E. BURZLAFF, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THILO
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURZLAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:210-657-4241
Mailing Address - Street 1:13909 NACOGDOCHES RD
Mailing Address - Street 2:SUITE 105 PMB 205
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1299
Mailing Address - Country:US
Mailing Address - Phone:210-657-4241
Mailing Address - Fax:210-657-4243
Practice Address - Street 1:8530 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5504
Practice Address - Country:US
Practice Address - Phone:210-657-4241
Practice Address - Fax:210-657-4243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0039HQOtherBCBS GROUP #
TX8F7280OtherBCBS INDIVIDUAL #
TX00295TMedicare ID - Type UnspecifiedMEDICARE GROUP #
TXG64647Medicare UPIN
TX8F7280OtherBCBS INDIVIDUAL #