Provider Demographics
NPI:1720073992
Name:BURKHART, JACOB PAUL III (DO)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:PAUL
Last Name:BURKHART
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 MACKENZIE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2967
Mailing Address - Country:US
Mailing Address - Phone:614-273-2250
Mailing Address - Fax:614-273-2255
Practice Address - Street 1:477 COOPER RD.
Practice Address - Street 2:SUITE 480
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081
Practice Address - Country:US
Practice Address - Phone:614-823-7135
Practice Address - Fax:614-823-7137
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005913207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2027014Medicaid
G56924Medicare UPIN
BU0831122Medicare ID - Type Unspecified
OH2027014Medicaid