Provider Demographics
NPI:1083092258
Name:CURTIS, BURL LEE
Entity Type:Individual
Prefix:
First Name:BURL
Middle Name:LEE
Last Name:CURTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 W WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440-1098
Mailing Address - Country:US
Mailing Address - Phone:231-672-3326
Mailing Address - Fax:231-672-3319
Practice Address - Street 1:565 W WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1098
Practice Address - Country:US
Practice Address - Phone:231-672-3326
Practice Address - Fax:231-672-3319
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker