Provider Demographics
NPI:1497735310
Name:BURTON, RIDHU CHOPRA (MD)
Entity Type:Individual
Prefix:DR
First Name:RIDHU
Middle Name:CHOPRA
Last Name:BURTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4169 LEGACY PKWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4258
Mailing Address - Country:US
Mailing Address - Phone:517-394-6500
Mailing Address - Fax:517-393-4202
Practice Address - Street 1:4169 LEGACY PKWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4258
Practice Address - Country:US
Practice Address - Phone:517-394-6500
Practice Address - Fax:517-393-4202
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB049536207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4442252Medicaid
MION61340Medicare ID - Type Unspecified
MIG51878Medicare UPIN