Basic Information
| Provider Information | |||||||||
| NPI: | 1366428500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURMEISTER | ||||||||
| FirstName: | GLEN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 E HAMPDEN AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 05/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 17672 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1679513196 | 05 | UT | MEDICAID | 300090006 | 01 | CO | RR MCRE DIA | OTHER | XPY201235 | 01 | CA | CA MEDICAID | OTHER | 53212901 | 01 | TX | TX MEDICAID | OTHER | 922288 | 01 | AZ | AZ MEDICAID | OTHER | 10025709000 | 05 | NE | MEDICAID | 84-0597929 | 05 | NE | MEDICAID | NA1215056 | 01 | NE | WPS NA 1215 RIN MCR PIN | OTHER | 1366428500 | 05 | WY | MEDICAID | 8492233 | 01 | WA | WA MEDICAID | OTHER | CO305780 | 01 | NE | MEDICARE TRAILBLAZER | OTHER | 01176726 | 05 | CO | MEDICAID | 1366428500 | 05 | MT | MEDICAID | 200418410A | 01 | KS | KS MEDICAID | OTHER | 104686051 | 01 | MI | MI MEDICAID | OTHER | 300048674 | 01 | CO | RR MCRE MIC | OTHER | 300090005 | 01 | CO | RR MCRE RIA | OTHER | 85429562 | 05 | NM | MEDICAID | NA1214056 | 01 | NE | WPS NA 1214 RIN MCR PIN | OTHER | 02312247 | 01 | NY | NY MEDICAID | OTHER |