MEDICARE: MICHAEL BERGER LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	8677222-1201	UT

General Provider Information

NPI Number	:	1023516473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BERGER LAC

Provider Business Mailing Address
First Line	:	928 EAGLE WAY
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-3330
Country	:	US
Telephone Number	:	385-888-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3194 S 1100 E STE 102
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2526
Country	:	US
Telephone Number	:	385-888-6900
Fax Number	:	385-888-6900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2018
Last Update Date	:	01/30/2018

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