Healthcare Provider Details

I. General information

NPI: 1427039072
Provider Name (Legal Business Name): RICHARD G BURKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4290 COPPER RIDGE DR STE 100A
TRAVERSE CITY MI
49684-7207
US

IV. Provider business mailing address

4290 COPPER RIDGE DR STE 100A
TRAVERSE CITY MI
49684-7207
US

V. Phone/Fax

Practice location:
  • Phone: 231-642-2202
  • Fax: 231-346-6029
Mailing address:
  • Phone: 231-642-2202
  • Fax: 231-346-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4310156303
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301056303
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: