Provider Demographics
NPI:1932151420
Name:BURNETT, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:BURNETT
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 1:1675 BIRDIE WAY APT B103
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3528
Mailing Address - Country:US
Mailing Address - Phone:901-493-0853
Mailing Address - Fax:
Practice Address - Street 1:300 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3307
Practice Address - Country:US
Practice Address - Phone:269-245-8056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY549562085R0001X
AL441812085R0001X
OH35.0536372085R0001X
MIEMC00056662085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3112409OtherTN BCBS
TN3828382Medicaid
TN5825694OtherAETNA
AR98023OtherAR BCBS
MS00120534Medicaid
AR137052001Medicaid
TN4169616OtherTN BCBS
MO204802904Medicaid
KY7100718550Medicaid
MS920000043Medicare PIN
TN3112409OtherTN BCBS
TN3828382Medicaid
TN38283841Medicare PIN