Healthcare Provider Details

I. General information

NPI: 1619068038
Provider Name (Legal Business Name): WINSTON FRANKLIN BURKE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7531 S STONY ISLAND AVE STE. 152
CHICAGO IL
60649-3954
US

IV. Provider business mailing address

4942 S ELLIS AVE LOWER LEVEL
CHICAGO IL
60615-2708
US

V. Phone/Fax

Practice location:
  • Phone: 773-947-7730
  • Fax:
Mailing address:
  • Phone: 773-268-2526
  • Fax: 773-268-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016-003298
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016003298
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: