Provider Demographics
NPI:1093979270
Name:BURROUGHS, DENISE MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 RAYBORN DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-1444
Mailing Address - Country:US
Mailing Address - Phone:517-882-2832
Mailing Address - Fax:
Practice Address - Street 1:5135 S PENN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4002
Practice Address - Country:US
Practice Address - Phone:517-887-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003528363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical