Healthcare Provider Details

I. General information

NPI: 1093378754
Provider Name (Legal Business Name): KIMBERLEE BURCKART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 8TH AVE W
CRESCO IA
52136-1064
US

IV. Provider business mailing address

321 8TH AVE W
CRESCO IA
52136-1064
US

V. Phone/Fax

Practice location:
  • Phone: 563-547-2022
  • Fax: 563-547-3448
Mailing address:
  • Phone: 563-547-2022
  • Fax: 563-547-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0007850
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0065129
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-50109
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: