Healthcare Provider Details

I. General information

NPI: 1639008170
Provider Name (Legal Business Name): NATHAN T BURNS JR. CPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15503 CHERRYLAWN ST
DETROIT MI
48238-1140
US

IV. Provider business mailing address

15503 CHERRYLAWN ST
DETROIT MI
48238-1140
US

V. Phone/Fax

Practice location:
  • Phone: 313-395-1436
  • Fax:
Mailing address:
  • Phone: 313-395-1436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: