Basic Information
Provider Information
NPI: 1649231754
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GURSES
FirstName: BURAK
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 788 N JEFFERSON ST
Address2: SUITE 300/ATTN. KAAREN BUTZEN
City: MILWAUKEE
State: WI
PostalCode: 532023718
CountryCode: US
TelephoneNumber: 4142728950
FaxNumber: 4142720859
Practice Location
Address1: 13133 N PORT WASHINGTON RD
Address2: SUITE 104
City: MEQUON
State: WI
PostalCode: 530972419
CountryCode: US
TelephoneNumber: 2622435044
FaxNumber: 2622432510
Other Information
ProviderEnumerationDate: 03/29/2006
LastUpdateDate: 11/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200X53195WIN Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
207RP1001X53195WIY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

ID Information
IDTypeStateIssuerDescription
164923175405WI MEDICAID


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