MEDICARE: MR. MARTIN C BURKE D.O.

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	207RC0001X	Clinical Cardiac Electrophysiology Physician	036-083340	IL

General Provider Information

NPI Number	:	1912917030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARTIN C BURKE D.O.

Provider Business Mailing Address
First Line	:	1006 S MICHIGAN AVE
Second Line	:	SUITE 501
City	:	CHICAGO
State	:	IL
Zip	:	60605-2254
Country	:	US
Telephone Number	:	773-726-0853
Fax Number	:	844-805-4742

Provider Business Practice Location Address
First Line	:	1006 S MICHIGAN AVE
Second Line	:	SUITE 501
City	:	CHICAGO
State	:	IL
Zip	:	60605-2254
Country	:	US
Telephone Number	:	773-726-0853
Fax Number	:	844-805-4742

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	02/13/2017

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