Doctor Name: | DR. JASON RICHARD BURNS |
NPI Number: | 1033409982 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 1155 N Mayfair Rd Tosa Center 3rd Floor Milwaukee, WI - 532263462 |
Business Phone Number: | 4149558990 |
Business Fax Number: | 4149556299 |
Mailing Address: | 1155 N Mayfair Rd, Tosa Center 3rd Floor MILWAUKEE |
State: | WI |
Postal Code: | 532263462 |
Phone Number: | 4149558990 |
Fax Number: | 4149556299 |
NPI Enumeration Date: | 04/12/2011 |
NPI Last Update Date: | 05/24/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |