1396700316 NPI number — KEVIN R BURKE M.D.

Table of content: KEVIN R BURKE M.D. (NPI 1396700316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396700316 NPI number — KEVIN R BURKE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKE
Provider First Name:
KEVIN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396700316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40295-0202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-272-5100
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3118 E 10TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47130-5904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-282-6979
Provider Business Practice Location Address Fax Number:
812-282-6998
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  01032568A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 21559 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50006205 . This is a "PASSPORT / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00000050935 . This is a "ANTHEM / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004281 . This is a "SIHO / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7588644001 . This is a "CIGNA / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110138281 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000023034A . This is a "HUMANA / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2447473000 . This is a "PASSPORT ADVANTAGE / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100075530 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1193932 . This is a "CHA / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64215593 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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