Healthcare Provider Details

I. General information

NPI: 1639973456
Provider Name (Legal Business Name): MATTHEW VERNON BURNETT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MCAULEY DR RM 4001
YPSILANTI MI
48197-1099
US

IV. Provider business mailing address

203 EDENWOOD DR APT 307
ANN ARBOR MI
48103-6978
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-3980
  • Fax:
Mailing address:
  • Phone: 720-318-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: