Basic Information
Provider Information
NPI: 1003019043
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOEKE
FirstName: KATHRYN
MiddleName: BURKHARDT
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BURKHARDT
OtherFirstName: KATHRYN
OtherMiddleName: JOAN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 11600 W 2ND PL
Address2:  
City: LAKEWOOD
State: CO
PostalCode: 802281527
CountryCode: US
TelephoneNumber: 7203210000
FaxNumber:  
Practice Location
Address1: 11600 W 2ND PL
Address2:  
City: LAKEWOOD
State: CO
PostalCode: 802281527
CountryCode: US
TelephoneNumber: 7203210000
FaxNumber: 7203211759
Other Information
ProviderEnumerationDate: 06/07/2007
LastUpdateDate: 04/11/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XDR.0044846CON Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000X35.091097OHN Allopathic & Osteopathic PhysiciansFamily Medicine 
208M00000XDR.0044846COY Allopathic & Osteopathic PhysiciansHospitalist 

ID Information
IDTypeStateIssuerDescription
290182805OH MEDICAID
4402472005CO MEDICAID


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