Provider Demographics
NPI:1114232238
Name:BURGESS, ANTHONY SANFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:SANFORD
Last Name:BURGESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W LAKE LANSING RD
Mailing Address - Street 2:SUITE C 120
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8445
Mailing Address - Country:US
Mailing Address - Phone:517-337-0957
Mailing Address - Fax:
Practice Address - Street 1:411 W LAKE LANSING RD
Practice Address - Street 2:SUITE C 120
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8445
Practice Address - Country:US
Practice Address - Phone:517-337-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010970977208M00000X, 207R00000X
MI4301097097207P00000X
OH35.124044207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine