Individual
DR. RIESA M. BURNETT
Active
Individual
DR. RIESA M. BURNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01067554A
IN
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
01067554A
IN
2086S0122X
Plastic and Reconstructive Surgery Physician
35.126101
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11014009A
TEMPORARY STATE LICENCE
IN
Enumeration date
05/25/2008
Last updated
06/06/2022
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