Provider Demographics
NPI:1144466160
Name:MICHAEL H. BURNAM, M.D. A MEDICAL CORP
Entity type:Organization
Organization Name:MICHAEL H. BURNAM, M.D. A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-609-7677
Mailing Address - Street 1:5525 ETIWANDA AVE.
Mailing Address - Street 2:SUITE #220
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6121
Mailing Address - Country:US
Mailing Address - Phone:818-609-7677
Mailing Address - Fax:818-609-0295
Practice Address - Street 1:5525 ETIWANDA AVE.
Practice Address - Street 2:SUITE #220
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6121
Practice Address - Country:US
Practice Address - Phone:818-609-7677
Practice Address - Fax:818-609-0295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL H. BURNAM, M.D. A MEDICAL CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25295207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A252950Medicaid
CAA24367Medicaid