Healthcare Provider Details

I. General information

NPI: 1235336652
Provider Name (Legal Business Name): DOUGLAS MICHAEL BURGESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 CHARLOTTE ST
KANSAS CITY MO
64108-2733
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2602
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-5709
  • Fax:
Mailing address:
  • Phone: 816-218-2523
  • Fax: 816-421-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number2011014010
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2011014010
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: