Basic Information
Provider Information
NPI: 1003008699
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURKE
FirstName: RYNN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8170 33RD AVE S
Address2: MS21110Q
City: MINNEAPOLIS
State: MN
PostalCode: 554254516
CountryCode: US
TelephoneNumber: 6123415000
FaxNumber: 6123711673
Practice Location
Address1: 2220 RIVERSIDE AVE
Address2: MAIL STOP 31700A
City: MINNEAPOLIS
State: MN
PostalCode: 554541321
CountryCode: US
TelephoneNumber: 6123415000
FaxNumber: 6123711673
Other Information
ProviderEnumerationDate: 08/16/2007
LastUpdateDate: 06/18/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X54261-20WIN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X50225MNY Allopathic & Osteopathic PhysiciansInternal Medicine 
208000000X50225MNN Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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