MEDICARE: DR. ALLEN RAY BURKETT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider	4301036813	MI

General Provider Information

NPI Number	:	1578869095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN RAY BURKETT M.D.

Provider Business Mailing Address
First Line	:	2274 SHADY GROVE LN
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-1365
Country	:	US
Telephone Number	:	734-850-2335
Fax Number	:

Provider Business Practice Location Address
First Line	:	2274 SHADY GROVE LN
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-1365
Country	:	US
Telephone Number	:	734-850-2335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2011
Last Update Date	:	03/07/2023

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