Provider Demographics
NPI:1457323065
Name:BURKE, EUGENE P (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:P
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:WAUKESHA HEALTH CARE INC.
Mailing Address - Street 2:N17 W24100 RIVERWOOD DRIVE SUITE 250
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:PROHEALTH CARE MEDICAL CENTERS-BROOKFIELD
Practice Address - Street 2:2085 N. CALHOUN ROAD
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-928-7100
Practice Address - Fax:262-713-7111
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI19463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31210400Medicaid
WIA39732Medicare UPIN
WI004268300Medicare PIN