Provider Demographics
NPI:1710968243
Name:BURGER, RICHARD JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:BURGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19942 SAINT JOSEPH DRIVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-8849
Mailing Address - Country:US
Mailing Address - Phone:641-856-8684
Mailing Address - Fax:641-856-3009
Practice Address - Street 1:19942 SAINT JOSEPH DRIVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-8849
Practice Address - Country:US
Practice Address - Phone:641-856-8684
Practice Address - Fax:641-856-3009
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMD16211207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD16211Medicaid
AKMD16211Medicaid
AKK151639Medicare ID - Type UnspecifiedDR. BURGER'S MEDICARE #