Provider Demographics
NPI:1699721274
Name:BURKARDT, BRIAN WILLIAM (DPM)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:WILLIAM
Last Name:BURKARDT
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 1:31017 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1907
Mailing Address - Country:US
Mailing Address - Phone:248-585-1177
Mailing Address - Fax:248-585-0083
Practice Address - Street 1:8391 COMMERCE RD STE 102
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4489
Practice Address - Country:US
Practice Address - Phone:248-363-3777
Practice Address - Fax:248-363-3577
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBB002128213ES0103X
MI5901002128213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBB002128OtherBLUE CROSS BLUE SHIELD
MIBB002128OtherBLUE CROSS FEP
MIMI1200002OtherMEDICARE PTAN
MIP00407374OtherRAILROAD
MIP41010002OtherMEDICARE PLUS BLUE
MI383749866OtherAETNA
MI383749866OtherHAP
MIP41010002OtherMEDICARE ADVANTAGE
MI5223395Medicaid
MIV09444OtherHEALTH ALLIANCE PLAN
MI156542OtherGREAT LAKES HEALTH PLAN
MIBB002128OtherBLUE CARE NETWORK
MIMI1200002OtherMEDICARE PTAN
MIV09444Medicare UPIN