Provider Demographics
NPI:1083161905
Name:BURKHARDT, JULIA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:MARIE
Last Name:BURKHARDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JULIA
Other - Middle Name:MARIE
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-551-3000
Practice Address - Fax:248-551-2426
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant