MEDICARE: DOUGLAS K. BURKE, MD PA

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	207RN0300X	Nephrology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0068MQ	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457384885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS K. BURKE, MD PA

Provider Business Mailing Address
First Line	:	2000 CRAWFORD ST
Second Line	:	SUITE 1405
City	:	HOUSTON
State	:	TX
Zip	:	77002-9000
Country	:	US
Telephone Number	:	713-654-7785
Fax Number	:	713-654-7795

Provider Business Practice Location Address
First Line	:	2000 CRAWFORD ST
Second Line	:	SUITE 1405
City	:	HOUSTON
State	:	TX
Zip	:	77002-9000
Country	:	US
Telephone Number	:	713-654-7785
Fax Number	:	713-654-7795

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOUGLAS KOSHIN BURKE
Credential	:	M.D.
Telephone Number	:	713-654-7785

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/15/2008

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