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General NPI Number Information
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NPI Number | 1487677878
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Entity Type | Organization
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Legal Business Name | CRAIG G. BURKHART, M.D., INC.
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 5600 MONROE ST BLDG B, SUITE 106
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City | SYLVANIA
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State | OH
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Zip | 43560-2731
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Country | US
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Telephone | 419-885-3403
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Fax | 419-885-3401
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Provider Business Mailing Address
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Address Line | 5600 MONROE ST BLDG B, SUITE 106
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City | SYLVANIA
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State | OH
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Zip | 43560-2731
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Country | US
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Telephone | 419-885-3403
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Fax | 419-885-3401
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Authorized Official
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Title or Position | DERMATOLOGIST
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Name | CRAIG G BURKHART
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Credential | M.D.
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Telephone | 419-885-3403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 35042675
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License Number State | OH
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