Provider Demographics
NPI:1639352115
Name:DR. RIDHU C. BURTON MD PC
Entity type:Organization
Organization Name:DR. RIDHU C. BURTON MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CASSADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-394-6500
Mailing Address - Street 1:4169 LEGACY PKWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4200
Mailing Address - Country:US
Mailing Address - Phone:517-394-6500
Mailing Address - Fax:517-393-4202
Practice Address - Street 1:4169 LEGACY PKWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4200
Practice Address - Country:US
Practice Address - Phone:517-394-6500
Practice Address - Fax:517-393-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS022073207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4703626Medicaid
MIA74161Medicare UPIN
MI0P11920Medicare PIN