Provider Demographics
NPI:1457398075
Name:BURKHARDT, CAROLYN RUTH (MD)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:RUTH
Last Name:BURKHARDT
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 1:5200 DTC PKWY
Mailing Address - Street 2:#280
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2709
Mailing Address - Country:US
Mailing Address - Phone:720-200-5454
Mailing Address - Fax:720-200-5460
Practice Address - Street 1:5200 DTC PKWY
Practice Address - Street 2:#280
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2709
Practice Address - Country:US
Practice Address - Phone:720-200-5454
Practice Address - Fax:720-200-5460
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C808014OtherMEDICARE ID
C808014OtherMEDICARE ID