Healthcare Provider Details

I. General information

NPI: 1013915321
Provider Name (Legal Business Name): SHELLEY ANNETTEQ BURKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LORAIN COMMUNITY HOSPITAL 3700 KOLBE ROAD
LORAIN OH
44053
US

IV. Provider business mailing address

COMMUNITY HOSPITALISTS, LLC PO BOX 39413
CLEVELAND OH
44139
US

V. Phone/Fax

Practice location:
  • Phone: 440-960-4000
  • Fax:
Mailing address:
  • Phone: 440-523-5023
  • Fax: 440-523-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35079927
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.079927
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: