Provider Demographics
NPI:1346229168
Name:BURKE, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
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:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0417
Mailing Address - Country:US
Mailing Address - Phone:772-223-2832
Mailing Address - Fax:772-223-5646
Practice Address - Street 1:501 SE OSCEOLA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2301
Practice Address - Country:US
Practice Address - Phone:772-288-5890
Practice Address - Fax:772-288-5840
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1220672085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259307600Medicaid
FL14YY6Medicare UPIN
FLIC401ZMedicare PIN