Provider Demographics
NPI:1366428500
Name:BURMEISTER, GLEN E (MD)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:E
Last Name:BURMEISTER
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 1:10700 E GEDDES AVE
Mailing Address - Street 2:NO 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO176722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1679513196Medicaid
CO300090006OtherRR MCRE DIA
CAXPY201235OtherCA MEDICAID
TX53212901OtherTX MEDICAID
AZ922288OtherAZ MEDICAID
NE10025709000Medicaid
NE84-0597929Medicaid
NENA1215056OtherWPS NA 1215 RIN MCR PIN
WY1366428500Medicaid
WA8492233OtherWA MEDICAID
NECO305780OtherMEDICARE TRAILBLAZER
CO01176726Medicaid
MT1366428500Medicaid
KS200418410AOtherKS MEDICAID
MI104686051OtherMI MEDICAID
CO300048674OtherRR MCRE MIC
CO300090005OtherRR MCRE RIA
NM85429562Medicaid
NENA1214056OtherWPS NA 1214 RIN MCR PIN
NY02312247OtherNY MEDICAID
CAXPY201235OtherCA MEDICAID
NM85429562Medicaid
CAXPY201235OtherCA MEDICAID
CO300090006OtherRR MCRE DIA
CO300090005OtherRR MCRE RIA
COE32540Medicare UPIN
NEP00796281Medicare PIN