Basic Information
| Provider Information | |||||||||
| NPI: | 1891831020 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKET | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 SHOAL CREEK BLVD STE 205N | ||||||||
| Address2: | AUSTIN HEART PLLC | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787571016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122064341 | ||||||||
| FaxNumber: | 5124071947 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 SAINT MARKS PL | ||||||||
| Address2: | STE. 160 | ||||||||
| City: | LA GRANGE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789451251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9792425677 | ||||||||
| FaxNumber: | 9792425680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | M6551 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0488397-06 | 05 | TX | MEDICAID |