Provider Demographics
NPI:1396708046
Name:BURKHALTER, EDWARD L (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:L
Last Name:BURKHALTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2400 S. MINNESOTA AVE.
Mailing Address - Street 2:STE. 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1417 S. CLIFF AVE.
Practice Address - Street 2:STE. 300
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1062
Practice Address - Country:US
Practice Address - Phone:605-322-8630
Practice Address - Fax:605-322-8631
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2014-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SD5516207RG0100X
SD9339207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN92411422906OtherPRIMEWEST
SD45358OtherSANFORD HEALTH PLAN
IA3185967Medicaid
SD57105B031OtherWPS TRICARE
MN186P6BUOtherCC SYSTEMS/ BLUE PLUS
SD370624200OtherDEPT OF LABOR
SD4994677OtherBLUE CROSS
SD6005120Medicaid
MN186P6BUOtherBLUE CROSS
SD2391537OtherARAZ/ AMERICA'S PPO
SD2900425OtherMEDICA
SD5516OtherDAKOTACARE
MN789434100Medicaid
SDHP55732OtherHEALTHPARTNERS
NE46022474338Medicaid
SD769171045255OtherPREFERRED ONE
SD11660OtherMIDLANDS CHOICE
SD4994677OtherBLUE CROSS
MN789434100Medicaid