Provider Demographics
NPI:1790712826
Name:BURMEISTER, ADAM ROBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:ROBERT
Last Name:BURMEISTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OAKLEAF WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2245
Mailing Address - Country:US
Mailing Address - Phone:715-832-1400
Mailing Address - Fax:715-832-4187
Practice Address - Street 1:1200 OAKLEAF WAY
Practice Address - Street 2:SUITE A
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2245
Practice Address - Country:US
Practice Address - Phone:715-832-1400
Practice Address - Fax:715-832-4187
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1094-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI01 20387OtherMEDICA/SELECTCARE EC
WI01 20388OtherMEDICA/SELECTCARE CF
WI991N4BUOtherBCBS MN
WI42978200Medicaid
P00724279OtherMEDICARE RAILROAD
WIS72757Medicare UPIN
WI01 20388OtherMEDICA/SELECTCARE CF
WI01 20387OtherMEDICA/SELECTCARE EC