Provider Demographics
NPI:1073750105
Name:BURDICK, DANIEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:BURDICK
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 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12039 NE 128TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3030
Practice Address - Country:US
Practice Address - Phone:425-899-3123
Practice Address - Fax:425-899-3114
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD601310252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0261761OtherLABOR & INDUSTRY
WA1073750105Medicaid
WA0261761OtherLABOR & INDUSTRY
G8903456Medicare PIN