Provider Demographics
NPI:1174694400
Name:BURKHART, DAVID MACDONALD (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MACDONALD
Last Name:BURKHART
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 1:600 N JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47405-3190
Mailing Address - Country:US
Mailing Address - Phone:812-855-6511
Mailing Address - Fax:812-855-4628
Practice Address - Street 1:600 N JORDAN AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-3190
Practice Address - Country:US
Practice Address - Phone:812-855-6511
Practice Address - Fax:812-855-4628
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0026178207Q00000X
IN01053733A207Q00000X
OH71262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE67131Medicare UPIN