Provider Demographics
NPI:1376581124
Name:BURKE, LINDA D (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:D
Last Name:BURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2287
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-9114
Mailing Address - Country:US
Mailing Address - Phone:208-939-2332
Mailing Address - Fax:208-939-7676
Practice Address - Street 1:445 S FITNESS PL
Practice Address - Street 2:STE130
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6552
Practice Address - Country:US
Practice Address - Phone:208-939-2332
Practice Address - Fax:208-939-7676
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM4709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C36971Medicare UPIN