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General NPI Number Information
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NPI Number | 1417179714
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Entity Type | Organization
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Legal Business Name | KRISTINE BURKE MD, INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 2390 E BIDWELL ST STE 100
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City | FOLSOM
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State | CA
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Zip | 95630-3873
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Country | US
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Telephone | 916-983-5771
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Fax | 916-983-6004
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Provider Business Mailing Address
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Address Line | 2390 E. BIDWELL STREET SUITE 100
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City | FOLSOM
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State | CA
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Zip | 95630
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Country | US
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Telephone | 916-983-5771
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Fax | 916-983-6004
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRISTINE LOUISE BURKE
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Credential |
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Telephone | 916-983-5771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 209800000X
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Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
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License Number | G79569
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | G079569
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G079569
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License Number State | CA
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