Individual
BRIAN LESLIE BURNETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 432-6049
Mailing address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 432-6049
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
49937
MN
207RH0003X
Hematology & Oncology Physician
Primary
60800
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050198000
—
MN
01
—
P00428374
MEDICARE RAILROAD
MN
Enumeration date
05/03/2007
Last updated
12/20/2021
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