Provider Demographics
NPI:1083826713
Name:BURKE MEDICAL GROUP LTD
Entity Type:Organization
Organization Name:BURKE MEDICAL GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-748-7500
Mailing Address - Street 1:3700 W 203RD STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1182
Mailing Address - Country:US
Mailing Address - Phone:708-748-7500
Mailing Address - Fax:708-748-8090
Practice Address - Street 1:3700 W 203RD STREET
Practice Address - Street 2:SUITE 310
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1182
Practice Address - Country:US
Practice Address - Phone:708-748-7500
Practice Address - Fax:708-748-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.616914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075518Medicaid
IL036075518Medicaid
IL543220Medicare ID - Type UnspecifiedMEDICAR GROUP NUMBER