Provider Demographics
NPI:1659734788
Name:BURT, HEATHER FAYE (DO)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:FAYE
Last Name:BURT
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 1:5492 N RONALD REAGAN PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-5618
Mailing Address - Country:US
Mailing Address - Phone:317-852-3861
Mailing Address - Fax:317-852-1246
Practice Address - Street 1:5492 N RONALD REAGAN PKWY STE 250
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-5618
Practice Address - Country:US
Practice Address - Phone:317-852-3851
Practice Address - Fax:317-852-1246
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN02005702A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty