Provider Demographics
NPI:1891780565
Name:BURNETT, LEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:
Last Name:BURNETT
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 1:2060 SPACE PARK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3600
Mailing Address - Country:US
Mailing Address - Phone:832-783-1999
Mailing Address - Fax:
Practice Address - Street 1:2060 SPACE PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3600
Practice Address - Country:US
Practice Address - Phone:832-783-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH19342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117383306Medicaid
TX8GD877OtherBCBS
TX00106WOtherMNA MDCR GRP PTAN HARRIS CO
TX0035TDOtherBCBSTX GRP PROV REC #
TX117383305Medicaid
TX153449704OtherMNA MDCD GRP TPI HARRIS CO
TX8FG394OtherBLUE CROSS BLUE SHIELD
TX153449704OtherMNA MDCD GRP TPI HARRIS CO
TX117383305Medicaid
TX117383306Medicaid