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General NPI Number Information
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NPI Number | 1649562869
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Entity Type | Individual
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Provider Name | BART ALLEN BURGER M.A., LLP
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Gender | Male
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Dates
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Enumeration Date | 05/05/2011
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 19368 MIDWAY RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4159
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Country | US
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Telephone | 248-752-4614
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Fax |
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Provider Business Mailing Address
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Address Line | 1026 W 11 MILE RD SUITE C
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City | ROYAL OAK
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State | MI
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Zip | 48067-5401
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Country | US
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Telephone | 248-752-4614
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301014598
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6361004274
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License Number State | MI
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