Provider Demographics
NPI:1285630046
Name:BURKITT, KEVIN GEORGE (AUD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:GEORGE
Last Name:BURKITT
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 MENTOR AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1459
Mailing Address - Country:US
Mailing Address - Phone:440-357-4327
Mailing Address - Fax:440-357-4328
Practice Address - Street 1:1701 MENTOR AVE STE 5
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1459
Practice Address - Country:US
Practice Address - Phone:440-357-4327
Practice Address - Fax:440-357-4328
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000339231H00000X
OHA.02301231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383517234OtherPPOM
MI140336OtherCARE CHOICES
MI640D726010OtherBLUE CROSS BLUE SHIELD
MIHA470001OtherMCARE
MIP34422FOtherBLUE CARE NETWORK
MI540D703020OtherBLUE CROSS BLUE SHIELD
MI904189234Medicaid