MEDICARE: DR. THOMAS D BERG M.D.

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	2085R0202X	Diagnostic Radiology Physician	32176	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27680	OTHER	IA	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	19308	OTHER	IA	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	27683	OTHER	IA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134175219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS D BERG M.D.

Provider Business Mailing Address
First Line	:	3089 ANITA DR NE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-9506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3089 ANITA DR NE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-9506
Country	:	US
Telephone Number	:	319-339-4284
Fax Number	:

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	09/12/2013

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