Provider Demographics
NPI:1154777555
Name:BURGER, KATLYNN ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:KATLYNN
Middle Name:ELIZABETH
Last Name:BURGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATLYNN
Other - Middle Name:ELIZABETH
Other - Last Name:COWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:18480 OPAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042
Mailing Address - Country:US
Mailing Address - Phone:248-842-3971
Mailing Address - Fax:
Practice Address - Street 1:44201 DEQUINDRE ROAD
Practice Address - Street 2:TROY BEAUMONT HOSPITAL
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085
Practice Address - Country:US
Practice Address - Phone:248-964-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant