Provider Demographics
NPI:1164733887
Name:BURTRUM, CATHERINE A (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:BURTRUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E MANSION ST
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1559
Mailing Address - Country:US
Mailing Address - Phone:269-781-4267
Mailing Address - Fax:
Practice Address - Street 1:215 E MANSION ST
Practice Address - Street 2:SUITE 3E
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1559
Practice Address - Country:US
Practice Address - Phone:269-781-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018728208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery