MEDICARE: MATTHEW H BURSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	4301506031	MI

General Provider Information

NPI Number	:	1316903834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW H BURSON MD

Provider Business Mailing Address
First Line	:	PO BOX 22040
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54305-2040
Country	:	US
Telephone Number	:	920-445-7222
Fax Number	:	920-445-7289

Provider Business Practice Location Address
First Line	:	515 28 3/4 RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-5016
Country	:	US
Telephone Number	:	970-683-7222
Fax Number	:	970-683-7276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	03/16/2022

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