Provider Demographics
NPI:1649278458
Name:BURKE, TIMOTHY G (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:G
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 1:4675 LINTON BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6615
Mailing Address - Country:US
Mailing Address - Phone:561-501-7445
Mailing Address - Fax:561-562-5061
Practice Address - Street 1:4675 LINTON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6615
Practice Address - Country:US
Practice Address - Phone:561-501-7445
Practice Address - Fax:561-562-5061
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD0057660207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001OtherBCBS
DCW8490006OtherBCBS
3550263OtherAETNA HMO
487760200OtherFEDERAL WORKMAN'S COMP
DCD3800001OtherBCBS
DCJ4570001OtherBCBS
497118OtherMAMSI
7407274OtherAETNA
MD61144806OtherBCBS
61144802OtherBCBS
61144803OtherBCBS
MD61144805OtherBCBS
DCJ4570001OtherBCBS
0001OtherBCBS
DCJ4570001OtherBCBS
61144802OtherBCBS
577MI260Medicare PIN