Provider Demographics
NPI:1396705828
Name:BURNER, TODD WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:WILLIAM
Last Name:BURNER
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 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:INTERNAL MEDICINE HOSPITALIST
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-0820
Mailing Address - Fax:414-805-0988
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:INTERNAL MEDICINE HOSPITALIST
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-0820
Practice Address - Fax:414-805-0988
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45342-020207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1396705828Medicaid
WI1396705828Medicaid