MEDICARE: MICHAEL BURRUSS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1992437230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BURRUSS

Provider Business Mailing Address
First Line	:	3232 W SHANLEY AVE
Second Line	:
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85120-0007
Country	:	US
Telephone Number	:	623-312-5465
Fax Number	:

Provider Business Practice Location Address
First Line	:	8149 E POSADA AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-1667
Country	:	US
Telephone Number	:	623-312-5465
Fax Number	:

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

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	04/23/2026

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