Provider Demographics
NPI:1528281862
Name:BURKART, BRADLEY GERARD (DPM)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:GERARD
Last Name:BURKART
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 4 2
Mailing Address - Street 2:30 NORTH 18TH AVENUE
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-3207
Mailing Address - Country:US
Mailing Address - Phone:920-743-6668
Mailing Address - Fax:
Practice Address - Street 1:BLDG 4 2
Practice Address - Street 2:30 NORTH 18TH AVENUE
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-3207
Practice Address - Country:US
Practice Address - Phone:920-743-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI747-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43223600Medicaid
WIP01633669OtherRAILROAD MEDICARE
WIU66884Medicare UPIN
WIK400278187Medicare PIN
WI43223600Medicaid