Provider Demographics
NPI:1194131813
Name:BURKS, ELI M (MD)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:M
Last Name:BURKS
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 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:402-483-4571
Mailing Address - Fax:402-483-5079
Practice Address - Street 1:515 22ND AVENUE
Practice Address - Street 2:MONROE CLINIC
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-2222
Practice Address - Fax:402-483-5079
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67093207R00000X, 208M00000X
WI67093-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist