Healthcare Provider Details

I. General information

NPI: 1124078662
Provider Name (Legal Business Name): JEFFREY SCOTT BURKETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 THEDA CLARK MEDICAL PLZ SUITE 400
NEENAH WI
54956-2763
US

IV. Provider business mailing address

905 WINDWARD CT
NEENAH WI
54956-4276
US

V. Phone/Fax

Practice location:
  • Phone: 920-725-4527
  • Fax: 920-725-0991
Mailing address:
  • Phone: 920-729-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35305
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35305
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35305
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35305
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number74450
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number35305
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: