Healthcare Provider Details

I. General information

NPI: 1366398315
Provider Name (Legal Business Name): MARC BURGEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8445 CONNOR
CENTER LINE MI
48015-1727
US

IV. Provider business mailing address

8445 CONNOR
CENTER LINE MI
48015-1727
US

V. Phone/Fax

Practice location:
  • Phone: 313-939-1496
  • Fax:
Mailing address:
  • Phone: 313-939-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: