Healthcare Provider Details

I. General information

NPI: 1124480868
Provider Name (Legal Business Name): MICHAEL BURROW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 HARVEST SPRINGS BLVD
CHUBBUCK ID
83202-1061
US

IV. Provider business mailing address

2100 PROVIDENCE WAY
IDAHO FALLS ID
83404-4951
US

V. Phone/Fax

Practice location:
  • Phone: 208-232-4133
  • Fax: 208-529-6602
Mailing address:
  • Phone: 208-529-6600
  • Fax: 208-529-6602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberM17832
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: