Provider Demographics
NPI:1659334118
Name:BURKETT, ELLEN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MARIE
Last Name:BURKETT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9088 RIDGELINE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2383
Mailing Address - Country:US
Mailing Address - Phone:720-266-6900
Mailing Address - Fax:303-791-9920
Practice Address - Street 1:9088 RIDGELINE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2383
Practice Address - Country:US
Practice Address - Phone:720-266-6900
Practice Address - Fax:303-791-9920
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2017-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO29558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01295583Medicaid
COE84037Medicare UPIN
COCC4118Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL