MEDICARE: DR. DEEPIKA D'CUNHA BURKARDT D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207SG0202X	Clinical Biochemical Genetics Physician	5101029027	MI
2	207SG0201X	Clinical Genetics (M.D.) Physician	5101029027	MI

General Provider Information

NPI Number	:	1902165392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEEPIKA D'CUNHA BURKARDT D.O.

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC 845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 MICHIGAN ST NE STE 2100
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2526
Country	:	US
Telephone Number	:	616-486-9830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	03/02/2026

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