Provider Demographics
NPI:1568478402
Name:BURNSTINE, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:BURNSTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 S GRAND AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3075
Mailing Address - Country:US
Mailing Address - Phone:213-234-1000
Mailing Address - Fax:213-234-1001
Practice Address - Street 1:1513 S GRAND AVE
Practice Address - Street 2:STE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3075
Practice Address - Country:US
Practice Address - Phone:213-234-1000
Practice Address - Fax:213-234-1001
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83967174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG839670Medicaid
CAOOG839670Medicaid
CAAV010ZMedicare PIN
CAWG83967FMedicare PIN