Individual
SHANE PATRICK BURKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
221 NE GLEN OAK AVE, PEORIA, IL 61636-0001
(309) 495-1640
Mailing address
900 MAIN ST, SUITE 720, PEORIA, IL 61602-1005
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0.36.150948
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2017
Last updated
09/01/2021
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