Provider Demographics
NPI:1639185390
Name:BURACK, MICHELLE A (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:BURACK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278984
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14627-8984
Mailing Address - Country:US
Mailing Address - Phone:585-273-1143
Mailing Address - Fax:585-242-9164
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-273-1143
Practice Address - Fax:585-242-9164
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050305582084N0400X
NY2465462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02956449Medicaid
NY02956449Medicaid
NYRB8076Medicare PIN