Individual
MR. ALBERT WILLIE BURRUS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8610A W POTOMAC AVE, MILWAUKEE, WI 53225-4138
(312) 505-2519
Mailing address
8610A W POTOMAC AVE, MILWAUKEE, WI 53225-4138
(312) 505-2519
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9211920762
—
WI
05
—
92192762
—
WI
Enumeration date
01/31/2023
Last updated
01/31/2023
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