Individual
MALISA M BURT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
127 FOREST AVE, ROYAL OAK, MI 48067-1843
(248) 229-7927
Mailing address
127 FOREST AVE, ROYAL OAK, MI 48067-1843
(248) 229-7927
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601002694
MI
Other
Enumeration date
04/29/2014
Last updated
04/29/2014
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