Provider Demographics
NPI:1821083015
Name:HANSEN, BURKE E (MD)
Entity Type:Individual
Prefix:DR
First Name:BURKE
Middle Name:E
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:30 MT HIGHWAY 91 S
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3535
Mailing Address - Country:US
Mailing Address - Phone:406-683-4252
Mailing Address - Fax:406-683-9403
Practice Address - Street 1:30 MT HIGHWAY 91 S
Practice Address - Street 2:SUITE 204
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3535
Practice Address - Country:US
Practice Address - Phone:406-683-4252
Practice Address - Fax:406-683-9403
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0047840Medicaid
MTH32040Medicare UPIN