Healthcare Provider Details

I. General information

NPI: 1376576546
Provider Name (Legal Business Name): DIANA BURMEISTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29275 NORTHWESTERN HWY STE 100
SOUTHFIELD MI
48034-1044
US

IV. Provider business mailing address

29275 NORTHWESTERN HWY STE 100
SOUTHFIELD MI
48034-1044
US

V. Phone/Fax

Practice location:
  • Phone: 877-784-3667
  • Fax: 248-784-3743
Mailing address:
  • Phone: 877-784-3667
  • Fax: 248-784-3743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SN0800X
TaxonomyNeuroscience Clinical Nurse Specialist
License Number5601002920
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: