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General NPI Number Information
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NPI Number | 1912273566
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Entity Type | Organization
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Legal Business Name | BURKMAN PODIATRY INC
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 1503 S US HIGHWAY 169 SUITE E
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City | SMITHVILLE
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State | MO
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Zip | 64089-9326
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Country | US
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Telephone | 816-873-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 1503 S US HIGHWAY 169 SUITE E
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City | SMITHVILLE
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State | MO
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Zip | 64089-9326
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Country | US
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Telephone | 816-873-3131
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BROCK BURKMAN
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Credential | DPM
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Telephone | 816-873-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 2010002111
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License Number State | MO
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