Provider Demographics
NPI:1477012524
Name:BURTON, DARCIE MAE (DO)
Entity Type:Individual
Prefix:DR
First Name:DARCIE
Middle Name:MAE
Last Name:BURTON
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 1:60 E MILWAUKEE ST UNIT 2268
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-8212
Mailing Address - Country:US
Mailing Address - Phone:734-564-1043
Mailing Address - Fax:
Practice Address - Street 1:3810 17 MILE RD # 1
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6831
Practice Address - Country:US
Practice Address - Phone:586-268-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101026630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program