Provider Demographics
NPI:1417179714
Name:KRISTINE BURKE MD, INC.
Entity Type:Organization
Organization Name:KRISTINE BURKE MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-983-5771
Mailing Address - Street 1:2390 E. BIDWELL STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-983-5771
Mailing Address - Fax:916-983-6004
Practice Address - Street 1:2390 E BIDWELL ST STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3873
Practice Address - Country:US
Practice Address - Phone:916-983-5771
Practice Address - Fax:916-983-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG079569207Q00000X, 207QS0010X
CAG79569209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24032ZMedicare ID - Type UnspecifiedGROUP NUMBER
CAG72890Medicare UPIN
CAH69917Medicare UPIN