Provider Demographics
NPI:1801017769
Name:BURKE, KRISTINE L (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
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 1:2390 E BIDWELL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3872
Mailing Address - Country:US
Mailing Address - Phone:916-983-5771
Mailing Address - Fax:916-983-6004
Practice Address - Street 1:2390 E BIDWELL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3872
Practice Address - Country:US
Practice Address - Phone:916-983-5771
Practice Address - Fax:916-983-6004
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG079569207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine