=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457384885
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUGLAS K. BURKE, MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 08/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 CRAWFORD ST SUITE 1405
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77002-9000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-654-7785
-----------------------------------------------------
Fax | 713-654-7795
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 CRAWFORD ST SUITE 1405
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77002-9000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-654-7785
-----------------------------------------------------
Fax | 713-654-7795
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DOUGLAS KOSHIN BURKE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-654-7785
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------