Healthcare Provider Details

I. General information

NPI: 1548557630
Provider Name (Legal Business Name): AMANDA MARIE BURNS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 JOHN R WOODEN DR
MARTINSVILLE IN
46151-1863
US

IV. Provider business mailing address

2200 JOHN R WOODEN DR
MARTINSVILLE IN
46151-1863
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-0112
  • Fax: 317-988-5512
Mailing address:
  • Phone: 317-988-0112
  • Fax: 317-988-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2011019840
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01074343A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: