Provider Demographics
NPI:1649573221
Name:BURKE & BURKE, MD, PC
Entity Type:Organization
Organization Name:BURKE & BURKE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-577-4230
Mailing Address - Street 1:940 E 3RD ST
Mailing Address - Street 2:SUITE # 202
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3237
Mailing Address - Country:US
Mailing Address - Phone:307-577-4230
Mailing Address - Fax:307-577-4238
Practice Address - Street 1:940 E 3RD ST
Practice Address - Street 2:SUITE # 202
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3237
Practice Address - Country:US
Practice Address - Phone:307-577-4230
Practice Address - Fax:307-577-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3302A207QA0505X
WY3300A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYA7298Medicare UPIN
WYA72998Medicare UPIN