Healthcare Provider Details

I. General information

NPI: 1790156354
Provider Name (Legal Business Name): M. BARBARA BURKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 E GALBRAITH RD STE 102
CINCINNATI OH
45236-2754
US

IV. Provider business mailing address

10028 S ROBERTS RD
PALOS HILLS IL
60465-1537
US

V. Phone/Fax

Practice location:
  • Phone: 513-924-8535
  • Fax: 513-924-8559
Mailing address:
  • Phone: 509-860-4064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number125.067910
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35133138
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: