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Individual

DR. RIESA M. BURNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
13450 N MERIDIAN ST STE 145, CARMEL, IN 46032-1484
(317) 338-8788
Mailing address
13450 N MERIDIAN ST STE 145, CARMEL, IN 46032-1484

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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