Healthcare Provider Details

I. General information

NPI: 1841576378
Provider Name (Legal Business Name): ASHLEY DURANT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY K BURDEX DO

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 ATWATER AVE
CIRCLEVILLE OH
43113-1301
US

IV. Provider business mailing address

41850 W 11 MILE RD STE 202
NOVI MI
48375-1857
US

V. Phone/Fax

Practice location:
  • Phone: 248-860-4634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.015120
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ0226
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: