Healthcare Provider Details

I. General information

NPI: 1861476285
Provider Name (Legal Business Name): MICHAEL BURT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 NAAB RD STE 250
INDIANAPOLIS IN
46260-5924
US

IV. Provider business mailing address

8333 NAAB RD STE 250
INDIANAPOLIS IN
46260-5924
US

V. Phone/Fax

Practice location:
  • Phone: 317-396-1300
  • Fax: 317-876-4070
Mailing address:
  • Phone: 317-396-1300
  • Fax: 317-876-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number01022687A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: