Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 4301405433 | MI |
NPI | 1033279906 |
---|---|
Provider Name | David A. Burks |
First Address | Ann Arbor, MI 48104-4014 |
Second Address | Ann Arbor, MI 48104-4014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 29/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
199523110 | (05) | MI |
E16049 | (02) |