Provider Demographics
NPI:1982622353
Name:BURGERS, JOHN K (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:BURGERS
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 1:100 METROPOLITAN PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5842
Mailing Address - Country:US
Mailing Address - Phone:315-870-9370
Mailing Address - Fax:315-870-9364
Practice Address - Street 1:300 CLYDE MORRIS BLVD STE C
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5909
Practice Address - Country:US
Practice Address - Phone:386-673-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060981208800000X
FLME158380208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0822668Medicaid
OH0822668Medicaid
OH0455924OtherRAILROAD MEDICARE
OH0684455Medicare PIN