Provider Demographics
NPI:1770542409
Name:BURNETT, MELISSA S (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:STROGATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6210 E HIGHWAY 290 STE 420
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9569
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:11714 WILSON PARKE AVE STE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-4061
Practice Address - Country:US
Practice Address - Phone:512-346-6611
Practice Address - Fax:512-406-6267
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065041208000000X
TXM7886208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189688803Medicaid
TX189688801Medicaid
TX189688802Medicaid
TX189688804Medicaid
AZ955817Medicaid
107591Medicare ID - Type Unspecified
TX189688803Medicaid
TX189688802Medicaid
TXTXB147376Medicare PIN
TX189688804Medicaid
TX189688801Medicaid