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General NPI Number Information
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NPI Number | 1669672325
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Entity Type | Individual
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Provider Name | MICHAEL A BURCHETT DO
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Gender | Male
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 855 ILLINI DR SUITE 304
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City | SILVIS
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State | IL
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Zip | 61282-2907
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Country | US
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Telephone | 309-281-2120
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Fax | 309-281-2129
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Provider Business Mailing Address
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Address Line | 865 LINCOLN RD SUITE L10
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City | BETTENDORF
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State | IA
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Zip | 52722-4190
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Country | US
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Telephone | 563-355-9200
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Fax | 563-355-3419
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 5101017495
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License Number State | MI
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