Healthcare Provider Details

I. General information

NPI: 1649573221
Provider Name (Legal Business Name): BURKE & BURKE, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 E 3RD ST SUITE # 202
CASPER WY
82601-3237
US

IV. Provider business mailing address

940 E 3RD ST SUITE # 202
CASPER WY
82601-3237
US

V. Phone/Fax

Practice location:
  • Phone: 307-577-4230
  • Fax: 307-577-4238
Mailing address:
  • Phone: 307-577-4230
  • Fax: 307-577-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number3302A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3300A
License Number StateWY

VIII. Authorized Official

Name: THOMAS M BURKE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 307-577-4230