Provider Demographics
NPI:1427193242
Name:BURKHART, KENNETH L (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:BURKHART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 NW 78TH AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1835
Mailing Address - Country:US
Mailing Address - Phone:305-269-7374
Mailing Address - Fax:
Practice Address - Street 1:1200 NW 78TH AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1835
Practice Address - Country:US
Practice Address - Phone:305-269-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20530207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology