Provider Demographics
NPI:1154355006
Name:DAVID J. BURKHARD, INC.
Entity type:Organization
Organization Name:DAVID J. BURKHARD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BURKHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-883-1476
Mailing Address - Street 1:7110 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-8517
Mailing Address - Country:US
Mailing Address - Phone:317-883-1476
Mailing Address - Fax:317-883-1476
Practice Address - Street 1:7110 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8517
Practice Address - Country:US
Practice Address - Phone:317-883-1476
Practice Address - Fax:317-883-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN250300AMedicare PIN
IN250300Medicare PIN