Healthcare Provider Details

I. General information

NPI: 1215982251
Provider Name (Legal Business Name): SUSAN BURKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LAKE LANSING RD STE C2
LANSING MI
48912
US

IV. Provider business mailing address

1515 LAKE LANSING RD STE C2
LANSING MI
48912
US

V. Phone/Fax

Practice location:
  • Phone: 517-482-9582
  • Fax: 517-482-4304
Mailing address:
  • Phone: 517-482-9582
  • Fax: 517-482-4304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301057062
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: