Provider Demographics
NPI:1114165784
Name:BURCK, CARI C (DO)
Entity Type:Individual
Prefix:
First Name:CARI
Middle Name:C
Last Name:BURCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 HAL GREER BLVD
Mailing Address - Street 2:ATTN: TAMMIE SILVA
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3800
Mailing Address - Country:US
Mailing Address - Phone:304-526-2000
Mailing Address - Fax:
Practice Address - Street 1:1115 20TH ST STE 100
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-2072
Practice Address - Country:US
Practice Address - Phone:304-697-7000
Practice Address - Fax:304-697-7003
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03336207Q00000X
WV2760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000736415OtherANTHEM BCBS
OH0055051Medicaid
WV3810026499Medicaid
WVWV3148AMedicare PIN
OH0055051Medicaid