Provider Demographics
NPI:1104853001
Name:BURTIS, MATIJA M (DO)
Entity Type:Individual
Prefix:DR
First Name:MATIJA
Middle Name:M
Last Name:BURTIS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:190 RIVERSIDE STREET
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103
Mailing Address - Country:US
Mailing Address - Phone:207-661-2095
Mailing Address - Fax:207-661-2033
Practice Address - Street 1:12 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-661-6064
Practice Address - Fax:207-253-6073
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME1685207Q00000X
MEDO16852083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME312400099Medicaid
MEMM8454Medicare PIN
ME312400099Medicaid