Provider Demographics
NPI:1750375887
Name:BURKET, MARK W (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:BURKET
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3355 GLENDALE AVE 3RD FL
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-931-0030
Mailing Address - Fax:419-931-0032
Practice Address - Street 1:28442 E RIVER RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2795
Practice Address - Country:US
Practice Address - Phone:419-931-0030
Practice Address - Fax:419-931-0032
Is Sole Proprietor?:No
Enumeration Date:2005-09-05
Last Update Date:2018-02-08
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Provider Licenses
StateLicense IDTaxonomies
OH35046181207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0592130Medicaid
C02890Medicare UPIN
C02890Medicare UPIN