Healthcare Provider Details

I. General information

NPI: 1124757141
Provider Name (Legal Business Name): KAITLIN ELIZABETH BUHRKE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 N 23RD AVE STE 100
PHOENIX AZ
85021-4148
US

IV. Provider business mailing address

3746 FOOTHILL BLVD # B140
GLENDALE CA
91214-1740
US

V. Phone/Fax

Practice location:
  • Phone: 310-560-0188
  • Fax: 323-544-4248
Mailing address:
  • Phone: 310-445-5999
  • Fax: 323-544-4248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number012053
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: