Healthcare Provider Details

I. General information

NPI: 1356689533
Provider Name (Legal Business Name): LUKE LESLIE BURCHARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 S SUBER RD
GREER SC
29650
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-989-4609
  • Fax: 864-989-4610
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35064
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: