Provider Demographics
NPI:1336246966
Name:BURNHAM, JULIE ANNE-MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANNE-MARIE
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:BURNHAM
Other - Last Name:HICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1030 HARRINGTON ST
Mailing Address - Street 2:STE 205
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2967
Mailing Address - Country:US
Mailing Address - Phone:586-493-3188
Mailing Address - Fax:586-493-3191
Practice Address - Street 1:1030 HARRINGTON ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2967
Practice Address - Country:US
Practice Address - Phone:586-493-3188
Practice Address - Fax:586-493-3191
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJH0122962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG76123Medicare UPIN
MION61000Medicare ID - Type Unspecified