Provider Demographics
NPI:1598570830
Name:BURTKA, JAMES A JR
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:BURTKA
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 WOODWARD AVE APT 436
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2752
Mailing Address - Country:US
Mailing Address - Phone:248-210-3797
Mailing Address - Fax:
Practice Address - Street 1:540 E CANFIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1928
Practice Address - Country:US
Practice Address - Phone:248-210-3797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program