Provider Demographics
NPI:1407184179
Name:DAVID M. BURKONS, M.D., INC
Entity Type:Organization
Organization Name:DAVID M. BURKONS, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURKONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-297-2061
Mailing Address - Street 1:1611 S GREEN RD
Mailing Address - Street 2:004
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4128
Mailing Address - Country:US
Mailing Address - Phone:216-297-2061
Mailing Address - Fax:216-297-2034
Practice Address - Street 1:1611 S GREEN RD
Practice Address - Street 2:004
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4128
Practice Address - Country:US
Practice Address - Phone:216-297-2061
Practice Address - Fax:216-297-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040676207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0377784Medicaid
OHDA9385771Medicare PIN