Provider Demographics
NPI:1912917030
Name:BURKE, MARTIN C (DO)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:C
Last Name:BURKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1006 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2254
Mailing Address - Country:US
Mailing Address - Phone:773-726-0853
Mailing Address - Fax:844-805-4742
Practice Address - Street 1:1006 S MICHIGAN AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2254
Practice Address - Country:US
Practice Address - Phone:773-726-0853
Practice Address - Fax:844-805-4742
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-083340207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400316306Medicare PIN
ILF02156Medicare UPIN