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 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.091097 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DR.0044846 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | DR.0044846 | CO | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 2901828 | 05 | OH | MEDICAID | 44024720 | 05 | CO | MEDICAID |