MEDICARE: DR. JOHN FREDERICK BERRY 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	208100000X	Physical Medicine & Rehabilitation Physician	35978-020	WI

General Provider Information

NPI Number	:	1245224351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN FREDERICK BERRY M.D.

Provider Business Mailing Address
First Line	:	1105 VICKI DR
Second Line	:
City	:	TOMAH
State	:	WI
Zip	:	54660-1780
Country	:	US
Telephone Number	:	608-374-2120
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E VETERANS ST
Second Line	:
City	:	TOMAH
State	:	WI
Zip	:	54660-3105
Country	:	US
Telephone Number	:	608-372-1773
Fax Number	:

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	04/03/2013

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