Healthcare Provider Details

I. General information

NPI: 1083111462
Provider Name (Legal Business Name): ANDRZEJ JOZEF BURKAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N SAN FRANCISCO ST STE 200
FLAGSTAFF AZ
86001-3281
US

IV. Provider business mailing address

1020 N SAN FRANCISCO ST STE 200
FLAGSTAFF AZ
86001-3281
US

V. Phone/Fax

Practice location:
  • Phone: 928-774-2300
  • Fax: 928-214-2136
Mailing address:
  • Phone: 928-774-2300
  • Fax: 928-214-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number72957
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: