Healthcare Provider Details

I. General information

NPI: 1346723277
Provider Name (Legal Business Name): MICHAEL J BURNS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 BOTELHO DR STE 110
WALNUT CREEK CA
94596-5083
US

IV. Provider business mailing address

9 EQUESTRIAN CT
NOVATO CA
94945-2600
US

V. Phone/Fax

Practice location:
  • Phone: 925-934-3536
  • Fax: 925-934-0672
Mailing address:
  • Phone: 415-491-1210
  • Fax: 415-491-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberA117877
License Number StateCA

VIII. Authorized Official

Name: MARGARET RASKOWSKY
Title or Position: MANAGER
Credential:
Phone: 415-491-1210