Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 03610956 | IL |
N | 2080P0207X | Pediatric Hematology-Oncologist | 03610956 | IL |
N | 2080P0207X | Pediatric Hematology-Oncologist | 48856 | MN |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 60869 | WI |
NPI | 1134173842 |
---|---|
Provider Name | Michael James Burke |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226-4874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 07/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134173842 | (05) | WI |