Healthcare Provider Details

I. General information

NPI: 1003236936
Provider Name (Legal Business Name): MICHAEL JUDD BURKHOLZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 N CIRCLE DR
COLORADO SPRINGS CO
80909-1160
US

IV. Provider business mailing address

2940 N CIRCLE DR
COLORADO SPRINGS CO
80909-1160
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-7321
  • Fax: 719-635-2510
Mailing address:
  • Phone: 719-635-7321
  • Fax: 719-635-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number14281517-1204
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDR.0063317
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10048760
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: