Healthcare Provider Details

I. General information

NPI: 1023080991
Provider Name (Legal Business Name): SCOTT DAVID BURGESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 LEFFINGWELL AVE NE SUITE 200
GRAND RAPIDS MI
49525-6406
US

IV. Provider business mailing address

1111 LEFFINGWELL AVE NE SUITE 200
GRAND RAPIDS MI
49525-6406
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-7101
  • Fax: 616-464-6170
Mailing address:
  • Phone: 616-459-7101
  • Fax: 616-464-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301087092
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number4301087092
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301087092
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number4301087092
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: