Provider Demographics
NPI:1528160371
Name:BURSTEDT, DAVID E (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:BURSTEDT
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 1:105 S WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4667
Mailing Address - Country:US
Mailing Address - Phone:931-372-7716
Mailing Address - Fax:931-372-7717
Practice Address - Street 1:105 S WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4667
Practice Address - Country:US
Practice Address - Phone:931-372-7716
Practice Address - Fax:931-372-0087
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10053739207L00000X
UT11069136-1205207LP2900X
IDRPT-1815174400000X
TN61181207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ059073Medicaid