Healthcare Provider Details

I. General information

NPI: 1881685121
Provider Name (Legal Business Name): STEPHEN JOSEPH BURKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 1ST AVE NE
CEDAR RAPIDS IA
52402-5321
US

IV. Provider business mailing address

1948 1ST AVE NE
CEDAR RAPIDS IA
52402-5321
US

V. Phone/Fax

Practice location:
  • Phone: 319-364-0121
  • Fax: 319-364-5684
Mailing address:
  • Phone: 319-364-0121
  • Fax: 319-364-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number33458
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number33458
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number33458
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number33458
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: