Provider Demographics
NPI:1669461695
Name:BURKE, CHARLES R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2 S CASCADE AVE
Mailing Address - Street 2:140
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1624
Mailing Address - Country:US
Mailing Address - Phone:719-538-2950
Mailing Address - Fax:719-538-2996
Practice Address - Street 1:6340 BARNES RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-2602
Practice Address - Country:US
Practice Address - Phone:719-596-2900
Practice Address - Fax:719-570-0601
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO30640208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01308402Medicaid
CO01308402Medicaid
COF07928Medicare UPIN