MEDICARE: RICHARD G BURKE MD

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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	4310156303	MI
2	207L00000X	Anesthesiology Physician	4301056303	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427039072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD G BURKE MD

Provider Business Mailing Address
First Line	:	4290 COPPER RIDGE DR STE 100A
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7207
Country	:	US
Telephone Number	:	231-642-2202
Fax Number	:	231-346-6029

Provider Business Practice Location Address
First Line	:	4290 COPPER RIDGE DR STE 100A
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7207
Country	:	US
Telephone Number	:	231-642-2202
Fax Number	:	231-346-6029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	12/11/2025

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