Provider Demographics
NPI:1144760315
Name:BURRIS, TAKIA (JD)
Entity Type:Individual
Prefix:MS
First Name:TAKIA
Middle Name:
Last Name:BURRIS
Suffix:
Gender:F
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 W PIERCE ST APT 504
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1239
Mailing Address - Country:US
Mailing Address - Phone:414-324-9850
Mailing Address - Fax:
Practice Address - Street 1:4029 N 11TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-7005
Practice Address - Country:US
Practice Address - Phone:414-324-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator