Provider Demographics
NPI:1548805518
Name:BURGE, EDDIE LEE III
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:LEE
Last Name:BURGE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 JEFFRIES AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6562
Mailing Address - Country:US
Mailing Address - Phone:216-543-9633
Mailing Address - Fax:
Practice Address - Street 1:8222 JEFFRIES AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-6562
Practice Address - Country:US
Practice Address - Phone:216-543-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management