Provider Demographics
NPI:1538141932
Name:BURKE, MICHAEL (MD,FACS,FAAP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD,FACS,FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-2171
Mailing Address - Fax:956-362-8219
Practice Address - Street 1:2821 MICHAELANGELO DR
Practice Address - Street 2:STE 200
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1404
Practice Address - Country:US
Practice Address - Phone:956-362-8215
Practice Address - Fax:956-362-8219
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207T00000X207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136257609Medicaid
TX457812YNG9Medicare PIN
TX136257608Medicaid