Provider Demographics
NPI:1659140945
Name:BURKERT, RILEY JAMES
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:JAMES
Last Name:BURKERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4891 DESTINATION CT UNIT 102
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7088
Mailing Address - Country:US
Mailing Address - Phone:812-614-1072
Mailing Address - Fax:
Practice Address - Street 1:4891 DESTINATION CT UNIT 102
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7088
Practice Address - Country:US
Practice Address - Phone:812-614-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program