Provider Demographics
NPI:1457384885
Name:DOUGLAS K. BURKE, MD PA
Entity Type:Organization
Organization Name:DOUGLAS K. BURKE, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:KOSHIN
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-654-7785
Mailing Address - Street 1:2000 CRAWFORD ST
Mailing Address - Street 2:SUITE 1405
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-9000
Mailing Address - Country:US
Mailing Address - Phone:713-654-7785
Mailing Address - Fax:713-654-7795
Practice Address - Street 1:2000 CRAWFORD ST
Practice Address - Street 2:SUITE 1405
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9000
Practice Address - Country:US
Practice Address - Phone:713-654-7785
Practice Address - Fax:713-654-7795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0068MQOtherBLUE CROSS BLUE SHIELD
TX172737202Medicaid
TX172737202Medicaid