Basic Information
| Provider Information | |||||||||
| NPI: | 1528099157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 N RIVER RD STE 110 | ||||||||
| Address2: | RESURRECTION IMMEDIATE CARE & WORKPLUS | ||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600161272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478133510 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 150 N RIVER RD STE 110 | ||||||||
| Address2: | RESURRECTION IMMEDIATE CARE & WORKPLUS | ||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600161272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478133510 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 04/06/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 336051123 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036089348 | 05 | IL | MEDICAID | 1619414 | 01 | BCBS GROUP | OTHER |