Provider Demographics
NPI:1346723277
Name:MICHAEL J BURNS MD INC
Entity Type:Organization
Organization Name:MICHAEL J BURNS MD INC
Other - Org Name:MICHAEL J BURNS MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:RASKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-491-1210
Mailing Address - Street 1:9 EQUESTRIAN CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2600
Mailing Address - Country:US
Mailing Address - Phone:415-491-1210
Mailing Address - Fax:415-491-4647
Practice Address - Street 1:1777 BOTELHO DR STE 110
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5083
Practice Address - Country:US
Practice Address - Phone:925-934-3536
Practice Address - Fax:925-934-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117877207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA117877OtherLICENSE