Provider Demographics
NPI:1437310596
Name:BURNETT, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2500 N MAYFAIR RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1409
Mailing Address - Country:US
Mailing Address - Phone:414-475-9101
Mailing Address - Fax:414-475-9203
Practice Address - Street 1:2500 N MAYFAIR RD
Practice Address - Street 2:SUITE 220
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1415
Practice Address - Country:US
Practice Address - Phone:414-475-9101
Practice Address - Fax:414-475-9203
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63139207KA0200X
MI4301092230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine