Provider Demographics
NPI:1265619662
Name:BURNEY, GHAZALA A (MD)
Entity type:Individual
Prefix:DR
First Name:GHAZALA
Middle Name:A
Last Name:BURNEY
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 1:47049 SHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2174
Mailing Address - Country:US
Mailing Address - Phone:734-495-1575
Mailing Address - Fax:734-721-6955
Practice Address - Street 1:1651 S VENOY RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5514
Practice Address - Country:US
Practice Address - Phone:734-721-7055
Practice Address - Fax:734-721-6055
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064815207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4279485Medicaid
MI4279485Medicaid
MI0M82550Medicare PIN