Provider Demographics
NPI:1164558995
Name:CAROLYN BURKHARDT MD LLC
Entity Type:Organization
Organization Name:CAROLYN BURKHARDT MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BURKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-200-5454
Mailing Address - Street 1:5200 DTC PKWY
Mailing Address - Street 2:#280
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2709
Mailing Address - Country:US
Mailing Address - Phone:720-200-5454
Mailing Address - Fax:720-200-5460
Practice Address - Street 1:5200 DTC PKWY
Practice Address - Street 2:#280
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2709
Practice Address - Country:US
Practice Address - Phone:720-200-5454
Practice Address - Fax:720-200-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO280212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01280213Medicaid
C808014Medicare Oscar/Certification
COD205027Medicare UPIN