Basic Information
| Provider Information | |||||||||
| NPI: | 1427133222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | WYLIE | ||||||||
| MiddleName: | GILMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50095 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981455095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065436420 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY OF WASHINGTON MEDICAL CTR | ||||||||
| Address2: | 1959 NE PACIFIC ST | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981956127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066162135 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 12/06/2013 | ||||||||
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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 | 207R00000X | MD00017576 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207SG0201X | MD00017576 | WA | N | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) |
ID Information
| ID | Type | State | Issuer | Description | 1427133222 | 05 | WA | MEDICAID | 1778 | 01 | INTERNAL ID-MOTOR VEHICLE ID | OTHER |