Healthcare Provider Details

I. General information

NPI: 1225550049
Provider Name (Legal Business Name): ADAM WESLEY BURKE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/21/2022
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 WYOMING AVE
WEST PITTSTON PA
18643-2741
US

IV. Provider business mailing address

550 E 1400 N STE N
LOGAN UT
84341-2450
US

V. Phone/Fax

Practice location:
  • Phone: 570-654-4371
  • Fax: 570-654-0455
Mailing address:
  • Phone: 570-654-4371
  • Fax: 570-654-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number12047256-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: