Individual
MARK A. BURKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1270 E STATE ROAD 205, SUITE 150, COLUMBIA CITY, IN 46725-9499
(260) 248-9890
(260) 248-9895
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02002438A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000210720
ANTHEM
IN
01
—
00000968827 05
UNITED HEALTHCARE
—
01
—
110231565
RAILROAD MEDICARE
IN
01
—
12730
PHYSICIANS HEALTH PLAN
IN
05
—
200367950
—
IN
01
—
3937240004
MEDICARE DMEPOS
IN
01
—
4270901
AETNA
—
Enumeration date
12/06/2005
Last updated
03/25/2013
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