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General NPI Number Information
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NPI Number | 1790774990
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Entity Type | Individual
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Provider Name | MICHAEL N BURLESON MD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2350 BUHNE ST A
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City | EUREKA
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State | CA
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Zip | 95501-3238
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Country | US
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Telephone | 707-443-4593
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Fax | 707-443-6447
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Provider Business Mailing Address
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Address Line | 2350 BUHNE ST A
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City | EUREKA
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State | CA
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Zip | 95501-3238
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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 |
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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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | C326570
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License Number State | CA
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