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NPI Code Detail

MEDICARE: PROF. CONSTANCE ANGELA BURKE PA-C

MEDICARE:  PROF. CONSTANCE ANGELA BURKE  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant5601002877MI

General Provider Information

NPI Number : 1194076042
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. CONSTANCE ANGELA BURKE PA-C
Provider Business Mailing Address
First Line : 6553 ISLAND LAKE DR
Second Line :
City : BRIGHTON
State : MI
Zip : 48116-9571
Country : US
Telephone Number : 586-855-6783
Fax Number :
Provider Business Practice Location Address
First Line : 4001 W MCNICHOLS RD
Second Line :
City : DETROIT
State : MI
Zip : 48221-3038
Country : US
Telephone Number : 313-993-1773
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2012
Last Update Date : 03/21/2017

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Directions to “ PROF. CONSTANCE ANGELA BURKE PA-C” Practice Location

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