Healthcare Provider Details

I. General information

NPI: 1912917030
Provider Name (Legal Business Name): MARTIN C BURKE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 S MICHIGAN AVE SUITE 501
CHICAGO IL
60605-2254
US

IV. Provider business mailing address

1006 S MICHIGAN AVE SUITE 501
CHICAGO IL
60605-2254
US

V. Phone/Fax

Practice location:
  • Phone: 773-726-0853
  • Fax: 844-805-4742
Mailing address:
  • Phone: 773-726-0853
  • Fax: 844-805-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036-083340
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: