1801808654 NPI number — DR. JOSEPH E BURKHARDT DO

Table of content: DR. JOSEPH E BURKHARDT DO (NPI 1801808654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801808654 NPI number — DR. JOSEPH E BURKHARDT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKHARDT
Provider First Name:
JOSEPH
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801808654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 HERITAGE OAK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49015-4250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-979-6360
Provider Business Mailing Address Fax Number:
269-979-6380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 HERITAGE OAK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49015-4250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-979-6360
Provider Business Practice Location Address Fax Number:
269-979-6380
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  5101012741 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200041730 . This is a "RR MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 47623 . This is a "COMMUNITY CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4308470 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7607133 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: JB012741 . This is a "ST LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P25349F . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200000005551 . This is a "PHP-JSOUTH MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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