Provider Demographics
NPI:1033109699
Name:BURGERT, STEPHEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:BURGERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 E 13TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5161
Mailing Address - Country:US
Mailing Address - Phone:970-669-5432
Mailing Address - Fax:970-461-6275
Practice Address - Street 1:2555 E 13TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5161
Practice Address - Country:US
Practice Address - Phone:970-669-5432
Practice Address - Fax:970-461-6275
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39199207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123408100Medicaid
NE84081574413Medicaid
CO43601049Medicaid
P00382854OtherMEDICARE RAILROAD
CO43601049Medicaid
CO806779Medicare PIN