Provider Demographics
NPI:1699955641
Name:DR RIDHU C BURTON MD PC
Entity type:Organization
Organization Name:DR RIDHU C BURTON MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIDHU
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-394-6500
Mailing Address - Street 1:4169 LEGACY PKWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4200
Mailing Address - Country:US
Mailing Address - Phone:517-394-6500
Mailing Address - Fax:517-393-4202
Practice Address - Street 1:4169 LEGACY PKWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4200
Practice Address - Country:US
Practice Address - Phone:517-394-6500
Practice Address - Fax:517-393-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB049536207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4442252Medicaid
MI0303307191OtherBCBS
MIG51878Medicare UPIN
MI0303307191OtherBCBS