Provider Demographics
NPI:1639651326
Name:BURKE, JUDEEN DIAN
Entity Type:Individual
Prefix:MRS
First Name:JUDEEN
Middle Name:DIAN
Last Name:BURKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JUDEEN
Other - Middle Name:DIAN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1040 NW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6101
Mailing Address - Country:US
Mailing Address - Phone:954-728-9200
Mailing Address - Fax:
Practice Address - Street 1:1040 NW 10TH AVE
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-6101
Practice Address - Country:US
Practice Address - Phone:954-728-9200
Practice Address - Fax:954-728-8660
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9333412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine