MEDICARE: JULIE BURGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4704173704	MI

General Provider Information

NPI Number	:	1235520594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE BURGER

Provider Business Mailing Address
First Line	:	21001 GREEN HILL RD
Second Line	:	APT 275
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-4510
Country	:	US
Telephone Number	:	734-756-5792
Fax Number	:

Provider Business Practice Location Address
First Line	:	21001 GREEN HILL RD
Second Line	:	APT 275
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-4510
Country	:	US
Telephone Number	:	734-756-5792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	02/09/2015

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