Provider Demographics
NPI:1972593499
Name:BURTKA, JAMES A (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:BURTKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:36040 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4239
Mailing Address - Country:US
Mailing Address - Phone:586-939-9160
Mailing Address - Fax:586-939-0162
Practice Address - Street 1:36040 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4239
Practice Address - Country:US
Practice Address - Phone:586-939-9160
Practice Address - Fax:586-939-0162
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOEO6477004Medicaid
OE06477Medicare ID - Type Unspecified
MIOEO6477004Medicaid