Provider Demographics
NPI:1396904066
Name:MICHAEL L BURKS, M.D., P.C.
Entity type:Organization
Organization Name:MICHAEL L BURKS, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LUNDY
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-256-2496
Mailing Address - Street 1:3301 BERRYWOOD DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6517
Mailing Address - Country:US
Mailing Address - Phone:573-256-2496
Mailing Address - Fax:573-256-2230
Practice Address - Street 1:3301 BERRYWOOD DR
Practice Address - Street 2:SUITE 206
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6517
Practice Address - Country:US
Practice Address - Phone:573-256-2496
Practice Address - Fax:573-256-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8H14207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO504878901Medicaid
MOE73671Medicare UPIN