Individual
KENNETH ALAN BURCKARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6435 W JEFFERSON BLVD # 434, FORT WAYNE, IN 46804-6203
(260) 436-7875
(260) 432-9812
Mailing address
PO BOX 843603, DALLAS, TX 75284-3603
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01074085A
IN
207L00000X
Anesthesiology Physician
55448
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201250880
—
IN
05
—
7100458340
—
KY
Enumeration date
04/29/2010
Last updated
10/23/2024
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