MEDICARE: RYAN SCOT 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	208200000X	Plastic Surgery Physician	4301505386	MI
2	208200000X	Plastic Surgery Physician	80721	GA

General Provider Information

NPI Number	:	1639566094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN SCOT BURKE MD

Provider Business Mailing Address
First Line	:	4110 COPPER RIDGE DR STE 242
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-6721
Country	:	US
Telephone Number	:	231-929-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 COPPER RIDGE DR STE 242
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-6721
Country	:	US
Telephone Number	:	231-929-7700
Fax Number	:

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

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	12/29/2025

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