Provider Demographics
NPI:1447210380
Name:BURDAKIN, JOHN H JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:BURDAKIN
Suffix:JR
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 1:600 7TH ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2120
Mailing Address - Country:US
Mailing Address - Phone:319-558-0322
Mailing Address - Fax:319-558-0324
Practice Address - Street 1:600 7TH ST SE
Practice Address - Street 2:SUITE 101
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2120
Practice Address - Country:US
Practice Address - Phone:319-558-0322
Practice Address - Fax:319-558-0324
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042277207RH0003X
CO48592207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87989271Medicaid
MI102828505Medicaid
COCOAAA3867Medicare PIN
CO87989271Medicaid
MI102828505Medicaid