MEDICARE: DR. MARTHA S BURK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	2005019361	MO

General Provider Information

NPI Number	:	1194714477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA S BURK M.D.

Provider Business Mailing Address
First Line	:	1701 LACEY ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-5230
Country	:	US
Telephone Number	:	573-334-4822
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 LACEY ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-5230
Country	:	US
Telephone Number	:	573-334-4822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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