Individual
JACQUES BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-5000
(231) 346-6017
Mailing address
PO BOX 27127, LANSING, MI 48909-7127
(231) 346-6800
(231) 346-6017
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301070541
MI
208000000X
Pediatrics Physician
4301070541
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4234840
—
MI
05
—
4324722
—
MI
Enumeration date
07/14/2006
Last updated
08/16/2019
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