Provider Demographics
NPI:1376607028
Name:BURGER, AMBERLY L (MD)
Entity Type:Individual
Prefix:
First Name:AMBERLY
Middle Name:L
Last Name:BURGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:5314 LINCOLNWAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-4249
Practice Address - Country:US
Practice Address - Phone:574-256-9032
Practice Address - Fax:574-256-9049
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068286A207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200983920Medicaid
INP01472095OtherRR MEDICARE
IN000000909861OtherBCBS BMG FULTON
IN200983920Medicaid
INP01643140OtherRR MEDICARE
IN000000909861OtherBCBS BMG FULTON
IN200983920Medicaid