Provider Demographics
NPI:1073232385
Name:BURKS, EDDIE DYON (PSYD, MED)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:DYON
Last Name:BURKS
Suffix:
Gender:M
Credentials:PSYD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N DEARBORN ST UNIT 101277
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1046
Mailing Address - Country:US
Mailing Address - Phone:847-370-0700
Mailing Address - Fax:
Practice Address - Street 1:4423 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5802
Practice Address - Country:US
Practice Address - Phone:847-370-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist