Provider Demographics
NPI:1063590149
Name:BURNETT, STEVEN MARK (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 MOUND STREET US 41
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236
Mailing Address - Country:US
Mailing Address - Phone:941-957-3376
Mailing Address - Fax:941-951-1966
Practice Address - Street 1:1545 MOUND ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7787
Practice Address - Country:US
Practice Address - Phone:941-957-3376
Practice Address - Fax:941-951-1966
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49399207ND0101X
FLME0049399207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
11724Medicare ID - Type Unspecified
E73164Medicare UPIN