Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901013293 | MI |
N | 204E00000X | Oral & Maxillofacial Surgeon | 2901013293 | MI |
NPI | 1033147723 |
---|---|
Provider Name | Mark T. Burye |
First Address | Muskegon, MI 49444-1871 |
Second Address | Muskegon, MI 49444-1871 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4863700 | (05) | MI |
4863719 | (05) | MI |
97 0 F11036 0 | BLUE CROSS MEDICAL (01) | MI |
D800376 | BLUE CROSS DENTAL (01) | MI |
U98804 | (02) | MI |