Healthcare Provider Details

I. General information

NPI: 1144248048
Provider Name (Legal Business Name): JANE W BUROKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6085 HEARTLAND DR STE 208
ZIONSVILLE IN
46077-4433
US

IV. Provider business mailing address

2605 N LEBANON ST
LEBANON IN
46052-1476
US

V. Phone/Fax

Practice location:
  • Phone: 317-768-2222
  • Fax: 317-768-2229
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01064170A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-083773
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: