Provider Demographics
NPI:1447256821
Name:BURRY, MICHAEL G (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:BURRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28701 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2335
Mailing Address - Country:US
Mailing Address - Phone:734-427-9900
Mailing Address - Fax:734-427-8963
Practice Address - Street 1:28701 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2335
Practice Address - Country:US
Practice Address - Phone:734-427-9900
Practice Address - Fax:734-427-8963
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013199207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4131520Medicaid
MIG98197OtherHAP PROVIDER ID
MI5101013199OtherSTATE LICENSE NUMBER
MI5820645OtherBCBS PROVIDER ID
MIP103272OtherBCN PROVIDER ID
MIC6744OtherMCARE PROVIDER ID
MIC6744OtherMCARE PROVIDER ID