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General NPI Number Information
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NPI Number | 1124078662
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Entity Type | Individual
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Provider Name | JEFFREY SCOTT BURKETT M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 100 THEDA CLARK MEDICAL PLZ SUITE 400
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City | NEENAH
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State | WI
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Zip | 54956-2763
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Country | US
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Telephone | 920-725-4527
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Fax | 920-725-0991
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Provider Business Mailing Address
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Address Line | 905 WINDWARD CT
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City | NEENAH
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State | WI
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Zip | 54956-4276
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Country | US
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Telephone | 920-729-4773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 35305
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 35305
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 35305
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35305
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 74450
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | 35305
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License Number State | WI
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