Healthcare Provider Details

I. General information

NPI: 1154777555
Provider Name (Legal Business Name): KATLYNN ELIZABETH BURGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATLYNN ELIZABETH COWLING PA-C

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44201 DEQUINDRE ROAD TROY BEAUMONT HOSPITAL
TROY MI
48085
US

IV. Provider business mailing address

18480 OPAL DRIVE
MACOMB MI
48042
US

V. Phone/Fax

Practice location:
  • Phone: 248-964-5000
  • Fax:
Mailing address:
  • Phone: 248-842-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007740
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: