Provider Demographics
NPI:1487677878
Name:CRAIG G. BURKHART, M.D., INC.
Entity type:Organization
Organization Name:CRAIG G. BURKHART, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:G
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-885-3403
Mailing Address - Street 1:5600 MONROE ST
Mailing Address - Street 2:BLDG B, SUITE 106
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2731
Mailing Address - Country:US
Mailing Address - Phone:419-885-3403
Mailing Address - Fax:419-885-3401
Practice Address - Street 1:5600 MONROE ST
Practice Address - Street 2:BLDG B, SUITE 106
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2731
Practice Address - Country:US
Practice Address - Phone:419-885-3403
Practice Address - Fax:419-885-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042675207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000027630OtherANTHEM BCBS
OH00058OtherPARAMOUNT HEALTHCARE
OH298402332001OtherMEDICAL MUTUAL
MI1560520OtherMI MEDICAID
OH2809269Medicaid
OH0463132Medicare PIN
OH298402332001OtherMEDICAL MUTUAL