Healthcare Provider Details

I. General information

NPI: 1023067816
Provider Name (Legal Business Name): MICHAEL J BURRELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W UNIVERSITY AVE SUITE 403
MUNCIE IN
47303-3409
US

IV. Provider business mailing address

2525 W UNIVERSITY AVE SUITE 403
MUNCIE IN
47303-3409
US

V. Phone/Fax

Practice location:
  • Phone: 765-289-6381
  • Fax: 765-289-3883
Mailing address:
  • Phone: 765-289-9415
  • Fax: 765-289-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01033256A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: