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General NPI Number Information
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NPI Number | 1114232238
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Entity Type | Individual
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Provider Name | ANTHONY SANFORD BURGESS M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 411 W LAKE LANSING RD SUITE C 120
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City | EAST LANSING
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State | MI
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Zip | 48823-8445
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Country | US
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Telephone | 517-337-0957
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Fax |
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Provider Business Mailing Address
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Address Line | 411 W LAKE LANSING RD SUITE C 120
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City | EAST LANSING
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State | MI
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Zip | 48823-8445
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Country | US
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Telephone | 517-337-0957
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 43010970977
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301097097
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35.124044
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 43010970977
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License Number State | MI
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