Healthcare Provider Details

I. General information

NPI: 1831468032
Provider Name (Legal Business Name): STEVEN BURDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2011
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: 313-286-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4704204426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: