Provider Demographics
NPI:1760452684
Name:BURZYNSKI, MICHELE ANNETTE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANNETTE
Last Name:BURZYNSKI
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:PO BOX 120069
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012
Mailing Address - Country:US
Mailing Address - Phone:817-274-1999
Mailing Address - Fax:817-274-4671
Practice Address - Street 1:950 N DAVIS
Practice Address - Street 2:STE 2
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012
Practice Address - Country:US
Practice Address - Phone:817-277-4723
Practice Address - Fax:817-277-7407
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144201401Medicaid
8154NDMedicare ID - Type Unspecified
TX144201401Medicaid