Provider Demographics
NPI:1073774493
Name:MICHAEL S. BURKE, M.D., PLLC
Entity Type:Organization
Organization Name:MICHAEL S. BURKE, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-770-9887
Mailing Address - Street 1:20696 BOND RD NE STE C-210
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9015
Mailing Address - Country:US
Mailing Address - Phone:360-779-4807
Mailing Address - Fax:360-779-5613
Practice Address - Street 1:20696 BOND RD NE STE C-210
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9015
Practice Address - Country:US
Practice Address - Phone:360-779-4807
Practice Address - Fax:360-779-5613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0000373462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8243826Medicaid