Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 12372 | WV |
NPI | 1063511723 |
---|---|
Provider Name | Michael Warren Burkhart |
First Address | Glen Dale, WV 26038-1660 |
Second Address | Glen Dale, WV 26038-1660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B42628 | (02) |