1528099157 NPI number — DR. ANNE MARIA BURKE MD

Table of content: DR. ANNE MARIA BURKE MD (NPI 1528099157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528099157 NPI number — DR. ANNE MARIA BURKE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKE
Provider First Name:
ANNE
Provider Middle Name:
MARIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1528099157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 N RIVER RD STE 110
Provider Second Line Business Mailing Address:
RESURRECTION IMMEDIATE CARE & WORKPLUS
Provider Business Mailing Address City Name:
DES PLAINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60016-1272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-813-3510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 N RIVER RD STE 110
Provider Second Line Business Practice Location Address:
RESURRECTION IMMEDIATE CARE & WORKPLUS
Provider Business Practice Location Address City Name:
DES PLAINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60016-1272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-813-3510
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

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: 207Q00000X , with the licence number:  336051123 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036089348 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619414 . This is a "BCBS GROUP" identifier . This identifiers is of the category "OTHER".