Provider Demographics
NPI:1144248048
Name:BUROKER, JANE W (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:W
Last Name:BUROKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6085 HEARTLAND DR STE 208
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-4433
Practice Address - Country:US
Practice Address - Phone:317-768-2222
Practice Address - Fax:317-768-2229
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064170A208000000X
OH35-083773208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02493467Medicaid
IN200881620Medicaid
OHI04254Medicare UPIN
OH000000334357OtherANTHEM
OH02493467Medicaid
OHBU4130111Medicare ID - Type Unspecified