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NPI Code Detail

MEDICARE: DR. TRACIE VESTA BURCH M.D.

MEDICARE: DR. TRACIE VESTA BURCH M.D.
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
1207Q00000XFamily Medicine Physician4301086056MI

General Provider Information

NPI Number : 1649494956
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRACIE VESTA BURCH M.D.
Provider Business Mailing Address
First Line : 210 N LAFAYETTE ST
Second Line :
City : SOUTH LYON
State : MI
Zip : 48178-2048
Country : US
Telephone Number : 248-437-1744
Fax Number :
Provider Business Practice Location Address
First Line : 210 N LAFAYETTE ST
Second Line :
City : SOUTH LYON
State : MI
Zip : 48178-2048
Country : US
Telephone Number : 248-437-1744
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2007
Last Update Date : 07/23/2007

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