MEDICARE: ANISE T BURKI INC

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	207Q00000X	Family Medicine Physician	01028259	IN

General Provider Information

NPI Number	:	1639368244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANISE T BURKI INC

Provider Business Mailing Address
First Line	:	7457 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-2517
Country	:	US
Telephone Number	:	317-273-6363
Fax Number	:	317-273-6358

Provider Business Practice Location Address
First Line	:	7457 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-2517
Country	:	US
Telephone Number	:	317-273-6363
Fax Number	:	317-273-6358

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ANISE T BURKI
Credential	:	MD
Telephone Number	:	317-273-6363

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	11/19/2007

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