Basic Information
| Provider Information | |||||||||
| NPI: | 1740576487 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 DON WICKHAM DR | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347111979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525368840 | ||||||||
| FaxNumber: | 3525368841 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 DON WICKHAM DR | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347111979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525368840 | ||||||||
| FaxNumber: | 3525368841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2011 | ||||||||
| LastUpdateDate: | 04/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | ME120965 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | ME120965 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.