Provider Demographics
NPI:1093378754
Name:BURCKART, KIMBERLEE (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:BURCKART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 8TH AVE W
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:IA
Mailing Address - Zip Code:52136-1064
Mailing Address - Country:US
Mailing Address - Phone:563-547-2022
Mailing Address - Fax:563-547-3448
Practice Address - Street 1:321 8TH AVE W
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:IA
Practice Address - Zip Code:52136-1064
Practice Address - Country:US
Practice Address - Phone:563-547-2022
Practice Address - Fax:563-547-3448
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0065129207Q00000X
COTL.0007850390200000X
IAMD-50109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO900014495Medicaid