Provider Demographics
NPI:1154433100
Name:BURNETTE, MICHAEL CLAUDE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLAUDE
Last Name:BURNETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2470 BLOOMINGDALE AVE STE 123
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6403
Mailing Address - Country:US
Mailing Address - Phone:813-655-8096
Mailing Address - Fax:813-684-1610
Practice Address - Street 1:2470 BLOOMINGDALE AVE STE 123
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6403
Practice Address - Country:US
Practice Address - Phone:813-655-8096
Practice Address - Fax:813-684-1610
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0747924207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007208600Medicaid
FL660001355OtherRAILROAD MEDICARE
FL0072086-00Medicaid
30903ZMedicare PIN