Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901001081 | MI |
Y | 222Z00000X | Podiatrist | 5901001081 | MI |
NPI | 1053348359 |
---|---|
Provider Name | Dr. Michael Patrick Burk |
First Address | Novi, MI 48375-2950 |
Second Address | Novi, MI 48375-2950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 28/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4237912 | (05) | MI |
480034200 | RAILROAD MEDICARE (01) | MI |
48-5-63-5173-0 | BLUE CROSS PROVIDER NUMBE (01) | MI |
5943716 | AETNA PPO (01) | MI |
T34048 | (02) | MI |