Basic Information
| Provider Information | |||||||||
| NPI: | 1073004578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | THERESE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 E MEDICAL CENTER DRIVE SPC 5718 | ||||||||
| Address2: | D2204 MEDICAL PROFESSIONAL BUILDING | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346478100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 E MEDICAL CENTER DRIVE SPC 5718 | ||||||||
| Address2: | D2204 MEDICAL PROFESSIONAL BUILDING | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346478100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2018 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0006X | 4301504296 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics |
No ID Information.