Provider Demographics
NPI:1710522461
Name:BURK, JAMES WILLIAM
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:BURK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 MOTOR AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-4955
Mailing Address - Country:US
Mailing Address - Phone:262-544-0711
Mailing Address - Fax:262-544-1321
Practice Address - Street 1:1002 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-4955
Practice Address - Country:US
Practice Address - Phone:262-544-0711
Practice Address - Fax:262-544-1321
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator