Provider Demographics
NPI:1851385819
Name:BURCKARDT, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BURCKARDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-587-4799
Mailing Address - Fax:502-540-3730
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1882
Practice Address - Country:US
Practice Address - Phone:502-587-4799
Practice Address - Fax:502-540-3730
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2010-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY19655207L00000X
IN01061591A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64196553Medicaid
IN100345470Medicaid
KY0609094Medicare Oscar/Certification
KYP00453194Medicare PIN
KY64196553Medicaid