Provider Demographics
NPI:1962424168
Name:BURGER, STEPHEN K (M D)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:K
Last Name:BURGER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 MEMORIAL DR STE 250
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5373
Mailing Address - Country:US
Mailing Address - Phone:618-235-3378
Mailing Address - Fax:618-235-2620
Practice Address - Street 1:4700 MEMORIAL DR STE 250
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5373
Practice Address - Country:US
Practice Address - Phone:618-235-3378
Practice Address - Fax:618-235-2620
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360905742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090574Medicaid
ILG07484Medicare UPIN
IL036090574Medicaid