Provider Demographics
NPI:1093758237
Name:NORTHEASTERN FOOT CARE PLLC
Entity Type:Organization
Organization Name:NORTHEASTERN FOOT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-458-9888
Mailing Address - Street 1:ONE PLAZA SOUTH
Mailing Address - Street 2:PMB 317
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464
Mailing Address - Country:US
Mailing Address - Phone:918-456-3222
Mailing Address - Fax:918-456-3196
Practice Address - Street 1:217 N MUSKOGEE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-456-3222
Practice Address - Fax:918-456-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========002OtherBLUE CROSS
U62475Medicare UPIN
OK=========002OtherBLUE CROSS
OK1303280001Medicare ID - Type Unspecified