Healthcare Provider Details

I. General information

NPI: 1356605984
Provider Name (Legal Business Name): BENJAMIN EDWARD BURNS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 FASHION SQUARE BLVD STE 201
SAGINAW MI
48603-1375
US

IV. Provider business mailing address

4200 FASHION SQUARE BLVD STE 201
SAGINAW MI
48603-1375
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax: 888-815-3583
Mailing address:
  • Phone: 833-351-8255
  • Fax: 888-815-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number347185
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number347185
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301101583
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301101583
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: