1477095867 NPI number — DR. SUSAN GOSLING BURLAND PH. D.

Table of content: DR. SUSAN GOSLING BURLAND PH. D. (NPI 1477095867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477095867 NPI number — DR. SUSAN GOSLING BURLAND PH. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURLAND
Provider First Name:
SUSAN
Provider Middle Name:
GOSLING
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477095867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3748 N DAMEN AVE
Provider Second Line Business Mailing Address:
UNIT 1N
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60618-4984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-593-6767
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3748 N DAMEN AVE
Provider Second Line Business Practice Location Address:
UNIT 1N
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60618-4984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-593-6767
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  071003661 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com