Provider Demographics
NPI:1972710945
Name:MICHAEL P. BURK, D.P.M., PLLC
Entity Type:Organization
Organization Name:MICHAEL P. BURK, D.P.M., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BURK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-476-1500
Mailing Address - Street 1:39555 W 10 MILE RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2950
Mailing Address - Country:US
Mailing Address - Phone:248-476-1500
Mailing Address - Fax:248-476-0502
Practice Address - Street 1:39555 W 10 MILE RD
Practice Address - Street 2:SUITE 307
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2950
Practice Address - Country:US
Practice Address - Phone:248-476-1500
Practice Address - Fax:248-476-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001081213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4237912Medicaid
480F340830OtherBCBS
MI480034200OtherRAILROAD MEDICARE
4856351730OtherBCBS
4856351730OtherBCBS
MIT34048Medicare UPIN