Provider Demographics
NPI:1780764522
Name:BURTON, MICHAEL DENIS (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DENIS
Last Name:BURTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4008
Mailing Address - Country:US
Mailing Address - Phone:305-294-8900
Mailing Address - Fax:305-294-6201
Practice Address - Street 1:1446 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4008
Practice Address - Country:US
Practice Address - Phone:305-294-8900
Practice Address - Fax:305-294-6201
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045992502Medicaid