Provider Demographics
NPI:1407811524
Name:BURKE, WILLIAM VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:VINCENT
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 1:2307 W BROWARD BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1417
Mailing Address - Country:US
Mailing Address - Phone:954-792-1010
Mailing Address - Fax:954-792-1199
Practice Address - Street 1:2307 W BROWARD BLVD
Practice Address - Street 2:STE 200
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1417
Practice Address - Country:US
Practice Address - Phone:954-792-1010
Practice Address - Fax:954-792-1199
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75019207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263865700Medicaid
FL44994OtherBCBS
FL263865700Medicaid
FL44994XMedicare PIN