Provider Demographics
NPI:1053348359
Name:BURK, MICHAEL PATRICK (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:BURK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39555 W 10 MILE RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2950
Mailing Address - Country:US
Mailing Address - Phone:248-476-1500
Mailing Address - Fax:248-476-0502
Practice Address - Street 1:39555 W 10 MILE RD
Practice Address - Street 2:SUITE 307
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2950
Practice Address - Country:US
Practice Address - Phone:248-476-1500
Practice Address - Fax:248-476-0502
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001081213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4237912Medicaid
MI480034200OtherRAILROAD MEDICARE
MI5943716OtherAETNA PPO
MI48-5-63-5173-0OtherBLUE CROSS PROVIDER NUMBE
MI5943716OtherAETNA PPO
MI4237912Medicaid
0N10170001Medicare PIN