Active NPI
Malisa M Burt, PA
- Medical Physician Assistant
- Royal Oak, MI
National Provider Identifier
1578973657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 5601002694
- Practice address
- 127 Forest Ave
Royal Oak, MI 48067-1843 - Phone
- (248) 229-7927
- NPI assigned
- Apr 29, 2014
- Last updated
- Apr 29, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601002694 | MI | Primary |
Addresses
Primary practice location
127 Forest Ave
Royal Oak, MI 48067-1843
Mailing address
127 Forest Ave
Royal Oak, MI 48067-1843
Phone (248) 229-7927
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601002694 | MI | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398729600000",
"number": "1578973657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "127 FOREST AVE",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480671843",
"telephone_number": "248-229-7927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "127 FOREST AVE",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480671843",
"telephone_number": "248-229-7927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURT",
"first_name": "MALISA",
"middle_name": "M",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-04-29",
"last_updated": "2014-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MI",
"license": "5601002694",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Royal Oak, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.