Individual
DEREK L BURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
17325 VAN WAGONER RD, SPRING LAKE, MI 49456-9702
(616) 847-5145
Mailing address
17325 VAN WAGONER RD, SPRING LAKE, MI 49456-9702
(616) 847-5145
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704216633
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4935522
—
MI
01
—
500F111460
BCBSM
MI
Enumeration date
08/01/2006
Last updated
06/04/2013
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