Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | BP10048760 | TX |
N | 111NI0900X | Internist | BP10048760 | TX |
Y | 207RG0100X | Gastroenterologist | DR.0063317 | CO |
NPI | 1003236936 |
---|---|
Provider Name | Michael Judd Burkholz |
First Address | Colorado Springs, CO 80909-1160 |
Second Address | Colorado Springs, CO 80909-1160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2014 |
Last Update Date | 24/06/2020 |