Healthcare Provider Details

I. General information

NPI: 1396700316
Provider Name (Legal Business Name): KEVIN R BURKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 E 10TH ST SUITE A
JEFFERSONVILLE IN
47130-5904
US

IV. Provider business mailing address

PO BOX 950202
LOUISVILLE KY
40295-0202
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-6979
  • Fax: 812-282-6998
Mailing address:
  • Phone: 502-272-5100
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01032568A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21559
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: