MEDICARE: EDWARD BURKHARDT MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207T00000X	Neurological Surgery Physician	342826	LA

General Provider Information

NPI Number	:	1518499904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD BURKHARDT MD

Provider Business Mailing Address
First Line	:	PO BOX 2668
Second Line	:	BUSINESS CTR - INS CREDENTIALING
City	:	HAMMOND
State	:	LA
Zip	:	70404-2668
Country	:	US
Telephone Number	:	985-230-1682
Fax Number	:

Provider Business Practice Location Address
First Line	:	15784 MEDICAL ARTS DR, STE B
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1747
Country	:	US
Telephone Number	:	985-230-7400
Fax Number	:	985-230-7401

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

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	10/11/2024

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