Provider Demographics
NPI:1922262013
Name:BURKARD, WADE M (MD)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:M
Last Name:BURKARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 EMERSON PARK BLVD
Mailing Address - Street 2:#105
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1251 EMERSON PARK BLVD
Practice Address - Street 2:#105
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5360
Practice Address - Country:US
Practice Address - Phone:312-307-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51580-20207P00000X
FLME122097207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIBURKEWADOtherMERCYCARE INSURANCE
WI1922262013Medicaid
WI1922262013OtherBCBSWI
IL$$$$$$$$$ 1Medicaid
IL$$$$$$$$$ 1Medicaid