Provider Demographics
NPI:1558381210
Name:BURKE, STEPHEN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WILLIAM
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 1:140 N ROLLING HILL RD
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2027
Mailing Address - Country:US
Mailing Address - Phone:305-853-0805
Mailing Address - Fax:
Practice Address - Street 1:140 N ROLLING HILL RD
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2027
Practice Address - Country:US
Practice Address - Phone:305-853-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166798-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA64289Medicare UPIN