Provider Demographics
NPI:1689886582
Name:BURTNETT, WILLIAM S (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:BURTNETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-367-3360
Mailing Address - Fax:502-367-3365
Practice Address - Street 1:1850 BLUEGRASS AVE
Practice Address - Street 2:HIPS
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1161
Practice Address - Country:US
Practice Address - Phone:502-367-3360
Practice Address - Fax:502-367-3365
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2018-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01070126A207R00000X, 207RN0300X
KY43056207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201051050Medicaid
KY7100135250Medicaid