Provider Demographics
NPI:1295976256
Name:BURKE DERMATOLOGY SC
Entity type:Organization
Organization Name:BURKE DERMATOLOGY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-836-9981
Mailing Address - Street 1:2942 EVERGREEN PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7909
Mailing Address - Country:US
Mailing Address - Phone:720-836-9981
Mailing Address - Fax:720-386-9132
Practice Address - Street 1:2942 EVERGREEN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7909
Practice Address - Country:US
Practice Address - Phone:720-836-9981
Practice Address - Fax:720-386-9132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122682207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3932097OtherBLUE CROSS/BLUE SHIELD OF ILLINOIS