Provider Demographics
NPI:1023188869
Name:BUREK, KELLY (DPM)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:BUREK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SOUTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1370
Mailing Address - Country:US
Mailing Address - Phone:413-572-1606
Mailing Address - Fax:413-572-0526
Practice Address - Street 1:150 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1370
Practice Address - Country:US
Practice Address - Phone:413-572-1606
Practice Address - Fax:413-572-0526
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA480034968OtherRAILROAD MEDICARE
MAY70970Medicare ID - Type Unspecified
MA5493470001Medicare NSC
MA480034968OtherRAILROAD MEDICARE