Provider Demographics
NPI:1649562869
Name:BURGER, BART ALLEN (MA, LLP)
Entity Type:Individual
Prefix:MR
First Name:BART
Middle Name:ALLEN
Last Name:BURGER
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 W 11 MILE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-5401
Mailing Address - Country:US
Mailing Address - Phone:248-752-4614
Mailing Address - Fax:
Practice Address - Street 1:19368 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4159
Practice Address - Country:US
Practice Address - Phone:248-752-4614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014598103T00000X
MI6361004274103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist