Provider Demographics
NPI:1033377452
Name:BURGESS, ARDUTH MAUREEN (DO)
Entity type:Individual
Prefix:DR
First Name:ARDUTH
Middle Name:MAUREEN
Last Name:BURGESS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1910 W HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9335
Mailing Address - Country:US
Mailing Address - Phone:517-244-9092
Mailing Address - Fax:517-244-9641
Practice Address - Street 1:1910 W HOWELL RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9335
Practice Address - Country:US
Practice Address - Phone:517-244-9092
Practice Address - Fax:517-244-9641
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI#5101012962208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0153302115OtherBCBS