Healthcare Provider Details

I. General information

NPI: 1003337098
Provider Name (Legal Business Name): JENNIFER MARIE BURGART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FRANCE AVE S STE 400
EDINA MN
55435-2141
US

IV. Provider business mailing address

6565 FRANCE AVE S STE 400
EDINA MN
55435-2141
US

V. Phone/Fax

Practice location:
  • Phone: 952-225-1630
  • Fax:
Mailing address:
  • Phone: 952-225-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number7959
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: