Provider Demographics
NPI:1669672325
Name:BURCHETT, MICHAEL A (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:BURCHETT
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:SUITE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4190
Mailing Address - Country:US
Mailing Address - Phone:563-355-9200
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:855 ILLINI DR
Practice Address - Street 2:SUITE 304
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-2907
Practice Address - Country:US
Practice Address - Phone:309-281-2120
Practice Address - Fax:309-281-2129
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2021-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017495208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036132850-1Medicaid
IA1669672325Medicaid
IA1669672325Medicaid
IAI17989205Medicare PIN