Provider Demographics
NPI:1043279383
Name:BURCHETT, ANDREW WADE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WADE
Last Name:BURCHETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4509 S PRINCE OF PEACE PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-5830
Mailing Address - Country:US
Mailing Address - Phone:605-322-7705
Mailing Address - Fax:605-322-7713
Practice Address - Street 1:4509 S PRINCE OF PEACE PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-5830
Practice Address - Country:US
Practice Address - Phone:605-322-7705
Practice Address - Fax:605-322-7713
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA3606207Q00000X
SD5871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5611140Medicaid
IA3455329Medicaid