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General NPI Number Information
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NPI Number | 1861806382
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Entity Type | Individual
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Provider Name | NATHAN BURKLE D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 4455 S 108TH ST
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City | GREENFIELD
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State | WI
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Zip | 53228-2504
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Country | US
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Telephone | 414-427-5310
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Fax | 414-427-5311
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Provider Business Mailing Address
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Address Line | 4455 S 108TH ST
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City | GREENFIELD
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State | WI
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Zip | 53228-2504
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Country | US
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Telephone | 414-427-5310
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Fax | 414-427-5311
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 125-064514
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License Number State | IL
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