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General NPI Number Information
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NPI Number | 1134446263
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Entity Type | Individual
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Provider Name | KENNETH ALAN BURCKARDT M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 6435 W JEFFERSON BLVD # 434
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City | FORT WAYNE
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State | IN
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Zip | 46804-6203
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Country | US
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Telephone | 260-436-7875
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Fax | 260-432-9812
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Provider Business Mailing Address
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Address Line | PO BOX 843603
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City | DALLAS
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State | TX
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Zip | 75284-3603
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Country | US
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Telephone | 972-233-1999
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Fax | 972-233-3666
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01074085A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 55448
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License Number State | KY
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