Provider Demographics
NPI:1205814027
Name:BURKE, GERALD J (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26771 W 12 MILE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1539
Mailing Address - Country:US
Mailing Address - Phone:248-352-8815
Mailing Address - Fax:248-352-9157
Practice Address - Street 1:26771 W 12 MILE RD
Practice Address - Street 2:STE 105
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1539
Practice Address - Country:US
Practice Address - Phone:248-352-8815
Practice Address - Fax:248-352-9157
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032148207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1481927Medicaid
1632339Medicare ID - Type Unspecified
B44071Medicare UPIN