Provider Demographics
NPI:1710277298
Name:BURKE, ALLISON C (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:C
Last Name:BURKE
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 N RONALD REAGAN PKWY
Practice Address - Street 2:STE 206
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6911
Practice Address - Country:US
Practice Address - Phone:317-217-2888
Practice Address - Fax:317-217-2999
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075232A208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201096280Medicaid
IN267030052Medicare PIN
INP01574928Medicare PIN
IN145590091Medicare PIN