Provider Demographics
NPI:1487474300
Name:MARK BURGER DO LLC
Entity type:Organization
Organization Name:MARK BURGER DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-625-1464
Mailing Address - Street 1:10300 W CHARLESTON BLVD # 13-220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1037
Mailing Address - Country:US
Mailing Address - Phone:702-625-1464
Mailing Address - Fax:
Practice Address - Street 1:10301 JEFFREYS ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3922
Practice Address - Country:US
Practice Address - Phone:702-939-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty