Individual
MR. KENNETH D BURKHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 W BROADWAY, STE 6, COUNCIL BLUFFS, IA 51503
(712) 325-1990
(712) 325-0288
Mailing address
300 W BROADWAY, STE 6, COUNCIL BLUFFS, IA 51503
(712) 325-1990
(712) 325-0288
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21722
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0188946
—
IA
01
—
161803
MEDICARE FQHC
—
05
—
2183632
—
IA
Enumeration date
10/24/2005
Last updated
07/09/2008
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