Provider Demographics
NPI:1780659623
Name:BURKE, STEVEN FOSTER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:FOSTER
Last Name:BURKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52737-9302
Mailing Address - Country:US
Mailing Address - Phone:319-768-5858
Mailing Address - Fax:319-753-2301
Practice Address - Street 1:2409 SPRING ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS CITY
Practice Address - State:IA
Practice Address - Zip Code:52737-9302
Practice Address - Country:US
Practice Address - Phone:319-768-5858
Practice Address - Fax:319-753-2301
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001481363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0080200OtherMEDICAID GROUP
IA13238OtherMEDICARE PART B GROUP
IL8122859OtherBCBS GROUP
CP8565OtherMEDICARE RR
IA16D0387805OtherCLIA RIVER DRIVE
IA13238OtherBCBS GROUP
IA37512OtherBCBS
IL42106072402OtherMEDICAID GROUP
IA001481OtherIOWA PA LICENSE NUMBER
IA16-1801OtherMEDICARE NGS GROUP
IA5100759OtherCSC
IA5100759OtherCSC
IA001481OtherIOWA PA LICENSE NUMBER
IA5100759OtherCSC