Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G074638 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | G074638 | CA |
N | 207ND0900X | Dermatopathologist | G074638 | CA |
N | 207NP0225X | Pediatric Dermatologist | G074638 | CA |
N | 207NS0135X | Procedural Dermatology | G074638 | CA |
NPI | 1063455343 |
---|---|
Provider Name | Michael K Burns |
First Address | San Francisco, CA 94108 |
Second Address | San Francisco, CA 94108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 30/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F37140 | (02) |