Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01033256A | IN |
Y | 208600000X | Surgeon | 01033256A | IN |
NPI | 1023067816 |
---|---|
Provider Name | Michael J Burrell |
First Address | Muncie, IN 47303-3409 |
Second Address | Muncie, IN 47303-3409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 04/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000711219 | ANTHEM (01) | IN |
200112850 | (05) | IN |
D94702 | (02) | IN |
P00968535 | RR MEDICARE (01) | IN |