Provider Demographics
NPI:1033169974
Name:BURKHART, STEPHEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
Last Name:BURKHART
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:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078-0006
Mailing Address - Country:US
Mailing Address - Phone:270-988-3839
Mailing Address - Fax:270-988-3832
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078-9998
Practice Address - Country:US
Practice Address - Phone:270-988-3839
Practice Address - Fax:270-988-3832
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12013207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0391301OtherPERSONAL MEDICARE
KYC73570OtherUPIN
KY64120132Medicaid
KY64120132Medicaid
KY0391301OtherPERSONAL MEDICARE