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NPI Code Detail

MEDICARE: JONATHAN A BERGER MD

MEDICARE: JONATHAN A BERGER MD
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
12085R0202XDiagnostic Radiology Physician01037032AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093790255
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN A BERGER MD
Provider Business Mailing Address
First Line : PO BOXS 80070
Second Line :
City : FORT WAYNE
State : IN
Zip : 46898
Country : US
Telephone Number : 260-432-1568
Fax Number : 260-432-4969
Provider Business Practice Location Address
First Line : 5001 US HIGHWAY 30 W STE D
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-9701
Country : US
Telephone Number : 260-432-1568
Fax Number : 260-432-4969
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2005
Last Update Date : 10/02/2025

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Directions to “ JONATHAN A BERGER MD” Practice Location

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