Healthcare Provider Details

I. General information

NPI: 1568661361
Provider Name (Legal Business Name): CLINTON BURKETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE STE 300
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-1490
  • Fax: 954-989-0454
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME108371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: