Provider Demographics
NPI:1225550049
Name:BURKE, ADAM WESLEY (DPM)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:WESLEY
Last Name:BURKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E 1400 N
Mailing Address - Street 2:STE N
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2450
Mailing Address - Country:US
Mailing Address - Phone:570-654-4371
Mailing Address - Fax:570-654-0455
Practice Address - Street 1:810 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-2741
Practice Address - Country:US
Practice Address - Phone:570-654-4371
Practice Address - Fax:570-654-0455
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12047256-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC006875OtherMEDICAL LICENSE NUMBER