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NPI Code Detail

MEDICARE: MICHELLE R BURDETTE MD, RETIRED

MEDICARE: MICHELLE R BURDETTE MD, RETIRED
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
1207Q00000XFamily Medicine Physician16928WV

General Provider Information

NPI Number : 1649274044
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE R BURDETTE MD, RETIRED
Provider Business Mailing Address
First Line : 4605 MACCORKLE AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1311
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4605 MACCORKLE AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1311
Country : US
Telephone Number : 304-414-4800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 12/13/2022

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Directions to “ MICHELLE R BURDETTE MD, RETIRED” Practice Location

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