Provider Demographics
NPI:1730342668
Name:BURLINGAME, BRET (DO)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:BURLINGAME
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:STE 520
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1837
Mailing Address - Country:US
Mailing Address - Phone:517-364-5260
Mailing Address - Fax:517-364-5251
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:STE 520
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1837
Practice Address - Country:US
Practice Address - Phone:517-364-5260
Practice Address - Fax:517-364-5251
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2013-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017955208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1730342668Medicaid