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General NPI Number Information
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NPI Number | 1700544111
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Entity Type | Organization
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Legal Business Name | BURTON PRIMARY CARE PLLC
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 1501 S CENTER RD BLDG A
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City | BURTON
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State | MI
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Zip | 48509-1731
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Country | US
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Telephone | 810-691-7738
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Fax | 810-780-4457
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Provider Business Mailing Address
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Address Line | 1501 S CENTER RD BLDG A
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City | BURTON
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State | MI
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Zip | 48509-1731
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING/CREDEBTAILING
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Name | HOSSAM SHUKAIRY
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Credential |
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Telephone | 810-780-4490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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