Provider Demographics
NPI:1083676803
Name:BURTCH, JOSEPH R (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:BURTCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:1484 STRAITS DR
Practice Address - Street 2:SUITE #5
Practice Address - City:BAYCITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8718
Practice Address - Country:US
Practice Address - Phone:989-667-8740
Practice Address - Fax:989-667-8745
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB011276207R00000X
MI5101011276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4431203Medicaid
MIG50802Medicare UPIN
MI0N56770Medicare ID - Type UnspecifiedMEDICARE NUMBER
G50802Medicare UPIN