Provider Demographics
NPI:1619068038
Name:BURKE, WINSTON FRANKLIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:FRANKLIN
Last Name:BURKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4942 S ELLIS AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2708
Mailing Address - Country:US
Mailing Address - Phone:773-268-2526
Mailing Address - Fax:773-268-2526
Practice Address - Street 1:7531 S STONY ISLAND AVE
Practice Address - Street 2:STE. 152
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3954
Practice Address - Country:US
Practice Address - Phone:773-947-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003298213ES0103X
IL016-003298213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6001231OtherBLUE CROSS/ BLUE SHEILD
ILP37676Medicare UPIN
IL6001231OtherBLUE CROSS/ BLUE SHEILD