Provider Demographics
NPI:1790738466
Name:BURNETT, CLAY M (MD)
Entity type:Individual
Prefix:
First Name:CLAY
Middle Name:M
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9411 N OAK TRFY STE LL1
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-691-1655
Mailing Address - Fax:
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 520B
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-691-5198
Practice Address - Fax:816-346-7095
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01090546A208G00000X
FLME122005208G00000X
MO2023026441208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1790738466Medicaid
KS100448810AMedicaid
FLHZ289ZMedicare PIN
D60897Medicare UPIN
KS100448810AMedicaid