Provider Demographics
NPI:1639166747
Name:BURKOW, LESTER (DO)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:
Last Name:BURKOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 W DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MI
Mailing Address - Zip Code:49045-1106
Mailing Address - Country:US
Mailing Address - Phone:269-423-7028
Mailing Address - Fax:269-423-8282
Practice Address - Street 1:319 W DELAWARE ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MI
Practice Address - Zip Code:49045-1106
Practice Address - Country:US
Practice Address - Phone:269-423-7028
Practice Address - Fax:269-423-8282
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639166747Medicaid
MI3191668Medicaid
MI1235131137OtherBCBSM
E26279Medicare UPIN
MIH06012080Medicare PIN
MI1639166747Medicaid