Provider Demographics
NPI:1144298928
Name:BURKHEAD, DANIEL LEWIS (MD LTD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEWIS
Last Name:BURKHEAD
Suffix:
Gender:M
Credentials:MD LTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9920 W CHEYENNE AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7725
Mailing Address - Country:US
Mailing Address - Phone:702-316-2281
Mailing Address - Fax:702-316-2272
Practice Address - Street 1:9920 W CHEYENNE AVE
Practice Address - Street 2:STE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7725
Practice Address - Country:US
Practice Address - Phone:702-316-2281
Practice Address - Fax:702-316-2272
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9100208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018219Medicaid
V102690Medicare PIN
NVG78072Medicare UPIN
NV35457Medicare ID - Type Unspecified