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NPI Code Detail

MEDICARE: EDWARD BURKE

MEDICARE: EDWARD BURKE
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
12084P0800XPsychiatry Physician038034370IL

General Provider Information

NPI Number : 1407262314
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD BURKE
Provider Business Mailing Address
First Line : 5319 E LAKE SHORE DR
Second Line :
City : WONDER LAKE
State : IL
Zip : 60097-8726
Country : US
Telephone Number : 312-719-0987
Fax Number :
Provider Business Practice Location Address
First Line : 929 W FOSTER AVE
Second Line : STE. 3002
City : CHICAGO
State : IL
Zip : 60640-1491
Country : US
Telephone Number : 312-719-0987
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2014
Last Update Date : 07/11/2014

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Directions to “ EDWARD BURKE ” Practice Location

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