Provider Demographics
NPI:1427141936
Name:BURKHOLZ, DANIEL TODD (PA-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:TODD
Last Name:BURKHOLZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 LINTON BLVD
Mailing Address - Street 2:103
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6542
Mailing Address - Country:US
Mailing Address - Phone:561-381-4271
Mailing Address - Fax:561-381-4273
Practice Address - Street 1:5210 LINTON BLVD
Practice Address - Street 2:103
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6542
Practice Address - Country:US
Practice Address - Phone:561-381-4271
Practice Address - Fax:561-381-4273
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102413363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4665Medicare ID - Type Unspecified