Healthcare Provider Details

I. General information

NPI: 1083981724
Provider Name (Legal Business Name): STEPHEN BURDEN DBA MARY LEE COMMUNITY HEALTH & TRAINING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25712 GRAND RIVER AVE
REDFORD MI
48240-1431
US

IV. Provider business mailing address

24633 PEMBROOKE DR
SOUTHFIELD MI
48033-3159
US

V. Phone/Fax

Practice location:
  • Phone: 313-286-3031
  • Fax: 313-286-3135
Mailing address:
  • Phone: 248-719-4335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TONYA MARETTA MOSS
Title or Position: CLINICAL DIRECTOR
Credential: DNP, NP-C
Phone: 313-286-3031