Provider Demographics
NPI:1386735140
Name:BURKLUND, DEAN EVAN (PA)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:EVAN
Last Name:BURKLUND
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 HIGHLAND RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1975
Mailing Address - Country:US
Mailing Address - Phone:248-383-1030
Mailing Address - Fax:248-383-1031
Practice Address - Street 1:5220 HIGHLAND RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1975
Practice Address - Country:US
Practice Address - Phone:248-383-1030
Practice Address - Fax:248-383-1031
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant