Provider Demographics
NPI:1780617092
Name:BURDINE, VICKI ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:ELAINE
Last Name:BURDINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6362 W BOGGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BOGGSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46110-9731
Mailing Address - Country:US
Mailing Address - Phone:317-887-1348
Mailing Address - Fax:317-888-1104
Practice Address - Street 1:898 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1407
Practice Address - Country:US
Practice Address - Phone:317-887-1348
Practice Address - Fax:317-888-1104
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038302A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
INAB3285182OtherFEDERAL DEA
INAB3285182OtherFEDERAL DEA