Provider Demographics
NPI:1831437870
Name:BURRIS, ROBERT BRODIE (MS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRODIE
Last Name:BURRIS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1109
Mailing Address - Country:US
Mailing Address - Phone:734-975-2745
Mailing Address - Fax:
Practice Address - Street 1:2711 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1109
Practice Address - Country:US
Practice Address - Phone:734-975-2745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000054171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist