Provider Demographics
NPI:1639399686
Name:BURAK, KATHLEEN KELLY (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KELLY
Last Name:BURAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 GRASSLANDS RD
Mailing Address - Street 2:DEPT OF MEDICINE-MUNGER PAVILION
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1646
Mailing Address - Country:US
Mailing Address - Phone:914-493-8370
Mailing Address - Fax:914-594-4434
Practice Address - Street 1:95 GRASSLANDS RD
Practice Address - Street 2:DEPT OF MEDICINE-MUNGER PAVILION
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1646
Practice Address - Country:US
Practice Address - Phone:914-493-8370
Practice Address - Fax:914-594-4434
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09029515Medicaid
NY02903693Medicaid
LA1100099Medicaid
NY02903693Medicaid