Provider Demographics
NPI:1225054323
Name:BURKE, DOUGLAS KOSHIN (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:KOSHIN
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 1:2000 CRAWFORD ST
Mailing Address - Street 2:SUITE 1405
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-9000
Mailing Address - Country:US
Mailing Address - Phone:713-654-7785
Mailing Address - Fax:713-654-7795
Practice Address - Street 1:2000 CRAWFORD ST
Practice Address - Street 2:SUITE 1405
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9000
Practice Address - Country:US
Practice Address - Phone:713-654-7785
Practice Address - Fax:713-654-7795
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9496207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S2930OtherBLUE CROSS BLUE SHIELD
TX043980404Medicaid
TXTXB150336Medicare PIN
TX8S2930OtherBLUE CROSS BLUE SHIELD
TX043980404Medicaid