Healthcare Provider Details

I. General information

NPI: 1558307223
Provider Name (Legal Business Name): RAINA JO BURKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST SUITE 3R
DETROIT MI
48201-2153
US

IV. Provider business mailing address

221 N LIBERTY ST
BELLEVILLE MI
48111-2637
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberPENDING
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number22709
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: