MEDICARE: ERIN BURKE HURST M.D.

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	2084P0800X	Psychiatry Physician	036-116561	IL

General Provider Information

NPI Number	:	1578603593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN BURKE HURST M.D.

Provider Business Mailing Address
First Line	:	5555 S WOODLAWN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1620
Country	:	US
Telephone Number	:	773-702-9800
Fax Number	:	773-702-2011

Provider Business Practice Location Address
First Line	:	5737 S UNIVERSITY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1507
Country	:	US
Telephone Number	:	773-702-9800
Fax Number	:	773-702-2011

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	03/10/2015

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