Individual
MARK BURNSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2799 WEST GRAND BLVD, DETROIT, MI 48202
(313) 916-2600
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-7425
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301046293
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2839652
—
MI
01
—
30-0-H2-6107-0
BCBCM PIN
MI
01
—
300045474
MEDICARE RAILROAD CARRIER
—
Enumeration date
07/06/2006
Last updated
01/08/2019
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