MEDICARE: DR. DANIELA M BURCHHARDT M.D.

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	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	ME160142	FL
2	207YS0123X	Facial Plastic Surgery Physician	R7401	TX

General Provider Information

NPI Number	:	1205196961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELA M BURCHHARDT M.D.

Provider Business Mailing Address
First Line	:	2235 VENETIAN COURT
Second Line	:	SUITE 1
City	:	NAPLES
State	:	FL
Zip	:	34109-8728
Country	:	US
Telephone Number	:	239-596-9337
Fax Number	:	239-596-9466

Provider Business Practice Location Address
First Line	:	1333 3RD AVE S STE 201
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6498
Country	:	US
Telephone Number	:	239-307-4605
Fax Number	:

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

Provider Enumeration Date	:	05/29/2012
Last Update Date	:	06/05/2023

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