Healthcare Provider Details

I. General information

NPI: 1659734788
Provider Name (Legal Business Name): HEATHER FAYE BURT D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5492 N RONALD REAGAN PKWY STE 250
BROWNSBURG IN
46112-5618
US

IV. Provider business mailing address

5492 N RONALD REAGAN PKWY STE 250
BROWNSBURG IN
46112-5618
US

V. Phone/Fax

Practice location:
  • Phone: 317-852-3851
  • Fax: 317-852-1246
Mailing address:
  • Phone: 317-852-3861
  • Fax: 317-852-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02005702A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: