Provider Demographics
NPI:1699828962
Name:BURKHALTER, JO ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JO
Middle Name:ANNE
Last Name:BURKHALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 560TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-7236
Mailing Address - Country:US
Mailing Address - Phone:712-225-6393
Mailing Address - Fax:
Practice Address - Street 1:300 SIOUX VALLEY DRIVE
Practice Address - Street 2:TRUE MEDICAL BUILDING
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012
Practice Address - Country:US
Practice Address - Phone:712-225-0707
Practice Address - Fax:712-225-3232
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18436207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0185223Medicaid
E62627Medicare UPIN
48540Medicare ID - Type Unspecified