Provider Demographics
NPI:1629231188
Name:BURGARDT, CLAIRE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:ELIZABETH
Last Name:BURGARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:ELIZABETH
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 BARNHILL DR # EH202
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5112
Practice Address - Country:US
Practice Address - Phone:317-217-2800
Practice Address - Fax:317-274-8769
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11014556A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program