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NPI Code Detail

MEDICARE: DR. TANDEKA NIX BURKS MD

MEDICARE: DR. TANDEKA NIX BURKS 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
1207Q00000XFamily Medicine Physician200001515NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2132P3OTHERNCBCBS GROUP # 015CK

General Provider Information

NPI Number : 1689675001
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TANDEKA NIX BURKS MD
Provider Business Mailing Address
First Line : PO BOX 1070
Second Line :
City : CHARLOTTE
State : NC
Zip : 28201-1070
Country : US
Telephone Number : 800-476-8646
Fax Number : 919-382-3210
Provider Business Practice Location Address
First Line : 150 ROBESON ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28301-5570
Country : US
Telephone Number : 910-609-6350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 07/09/2007

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