Provider Demographics
NPI:1396700316
Name:BURKE, KEVIN R (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:BURKE
Suffix:
Gender:M
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:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-272-5100
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3118 E 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5904
Practice Address - Country:US
Practice Address - Phone:812-282-6979
Practice Address - Fax:812-282-6998
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032568A207R00000X
KY21559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
50006205OtherPASSPORT / NCMA
00000050935OtherANTHEM / NCMA
004281OtherSIHO / NCMA
7588644001OtherCIGNA / NCMA
IN110138281OtherRAILROAD MEDICARE
000023034AOtherHUMANA / NCMA
2447473000OtherPASSPORT ADVANTAGE / NCMA
IN100075530Medicaid
1193932OtherCHA / NCMA
KY64215593Medicaid
000023034AOtherHUMANA / NCMA
IN110138281OtherRAILROAD MEDICARE
IN196290DMedicare PIN