Healthcare Provider Details

I. General information

NPI: 1215178249
Provider Name (Legal Business Name): DEBORAH JEAN BURGIN RT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH JEAN FAVIO RT

II. Dates (important events)

Enumeration Date: 03/22/2009
Last Update Date: 03/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

10972 MAPLEVIEW ST
PINCKNEY MI
48169-8857
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-2573
  • Fax:
Mailing address:
  • Phone: 734-945-1706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: