Provider Demographics
NPI:1356358790
Name:BURNETT, DAVID JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:BURNETT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2102 BAPTISTE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1314
Mailing Address - Country:US
Mailing Address - Phone:913-557-0700
Mailing Address - Fax:866-254-5538
Practice Address - Street 1:2102 BAPTISTE DR
Practice Address - Street 2:SUITE D
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1314
Practice Address - Country:US
Practice Address - Phone:913-557-0700
Practice Address - Fax:866-254-5538
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00312213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4857030001OtherDMERC
4857030001OtherDMERC
KSU80292Medicare UPIN
KS4857030001Medicare NSC