Basic Information
| Provider Information | |||||||||
| NPI: | 1396888459 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | CHARITY | ||||||||
| MiddleName: | SPRING | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 E BROADWAY | ||||||||
| Address2: | SUITE 195 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026294263 | ||||||||
| FaxNumber: | 5026294282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | 01069811A | IN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 44381 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | 44381 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 201027930 | 05 | IN | MEDICAID | 139223 | 01 | KY | SIHO - LAH | OTHER | 000000786559 | 01 | KY | ANTHEM - LAH | OTHER | 50042940 | 01 | KY | PASSPORT - LAH | OTHER | 7100212670 | 05 | KY | MEDICAID |