Basic Information
| Provider Information | |||||||||
| NPI: | 1114232238 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURGESS | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | SANFORD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 W LAKE LANSING RD | ||||||||
| Address2: | SUITE C 120 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488238445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173370957 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 411 W LAKE LANSING RD | ||||||||
| Address2: | SUITE C 120 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488238445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173370957 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2010 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 43010970977 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist | 207P00000X | 4301097097 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 35.124044 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 43010970977 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.