Provider Demographics
NPI:1891800736
Name:BURKE, KELLY E (DO)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:BURKE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2210 DEL PASO RD
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-9676
Practice Address - Country:US
Practice Address - Phone:916-285-8100
Practice Address - Fax:916-285-8105
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
020A94800Medicare ID - Type Unspecified
I52303Medicare UPIN
CA020A94803Medicare PIN