MEDICARE: DR. ANDREW WADE BURCHETT D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	3606	IA
2	207Q00000X	Family Medicine Physician	5871	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043279383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW WADE BURCHETT D.O.

Provider Business Mailing Address
First Line	:	4509 S PRINCE OF PEACE PL
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-5830
Country	:	US
Telephone Number	:	605-322-7705
Fax Number	:	605-322-7713

Provider Business Practice Location Address
First Line	:	4509 S PRINCE OF PEACE PL
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-5830
Country	:	US
Telephone Number	:	605-322-7705
Fax Number	:	605-322-7713

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	01/17/2022

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