Healthcare Provider Details

I. General information

NPI: 1689008708
Provider Name (Legal Business Name): LUKE JOSEPH BURGDORF M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W SOUTH ST
KALAMAZOO MI
49007-4711
US

IV. Provider business mailing address

122 W SOUTH ST
KALAMAZOO MI
49007-4711
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-4219
  • Fax:
Mailing address:
  • Phone: 269-349-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301015648
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: