MEDICARE: MICHAEL N BURLESON 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	173000000X	Legal Medicine	C326570	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790774990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL N BURLESON MD

Provider Business Mailing Address
First Line	:	2350 BUHNE ST
Second Line	:	A
City	:	EUREKA
State	:	CA
Zip	:	95501-3238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 BUHNE ST
Second Line	:	A
City	:	EUREKA
State	:	CA
Zip	:	95501-3238
Country	:	US
Telephone Number	:	707-443-4593
Fax Number	:	707-443-6447

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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