Healthcare Provider Details

I. General information

NPI: 1932151420
Provider Name (Legal Business Name): JOHN A BURNETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5666 E STATE ST
ROCKFORD IL
61108-2425
US

IV. Provider business mailing address

5666 E STATE ST
ROCKFORD IL
61108-2425
US

V. Phone/Fax

Practice location:
  • Phone: 815-227-2273
  • Fax: 815-227-2658
Mailing address:
  • Phone: 815-227-2273
  • Fax: 815-227-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number66814
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036181005
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: