Provider Demographics
NPI:1245217967
Name:BURCKHARDT, JOSEPH GEORGE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GEORGE
Last Name:BURCKHARDT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 GREEN OAK TERRACE CT STE 100
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2960
Mailing Address - Country:US
Mailing Address - Phone:281-358-9889
Mailing Address - Fax:281-358-1465
Practice Address - Street 1:1414 GREEN OAK TERRACE CT STE 100
Practice Address - Street 2:100
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2960
Practice Address - Country:US
Practice Address - Phone:281-358-9889
Practice Address - Fax:281-358-1465
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0713213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092844201Medicaid
TX218871601OtherMEDICAID DME
TX218871601OtherMEDICAID DME
TX092844201Medicaid
TX8F24229Medicare PIN