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NPI Code Detail

MEDICARE: DR. THOMAS ZACHARY BURKLE AU.D.

MEDICARE: DR. THOMAS ZACHARY BURKLE AU.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
1231H00000XAudiologist23002551AIN

General Provider Information

NPI Number : 1699985275
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS ZACHARY BURKLE AU.D.
Provider Business Mailing Address
First Line : 4720 E STATE BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-6923
Country : US
Telephone Number : 260-471-5693
Fax Number : 260-471-4942
Provider Business Practice Location Address
First Line : 4720 E STATE BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-6923
Country : US
Telephone Number : 260-471-5693
Fax Number : 260-471-4942
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 05/02/2016

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