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NPI Code Detail

MEDICARE: KEITH V BJORGE PSYD PC

MEDICARE: KEITH V BJORGE PSYD PC
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
1103T00000XPsychologist2091057WI
2103TC0700XClinical Psychologist071005483IL

General Provider Information

NPI Number : 1790854636
Entity Type Code : Organization
Provider Name (Legal Business Name) : KEITH V BJORGE PSYD PC
Provider Business Mailing Address
First Line : 61 S OLD RAND RD
Second Line :
City : LAKE ZURICH
State : IL
Zip : 60047-3127
Country : US
Telephone Number : 815-578-4222
Fax Number : 847-438-0844
Provider Business Practice Location Address
First Line : 61 S OLD RAND RD
Second Line :
City : LAKE ZURICH
State : IL
Zip : 60047-3127
Country : US
Telephone Number : 815-578-4222
Fax Number : 847-438-0844
Authorized Official
Title or Position : PRESIDENT/PSYCHOLOGIST
Name : DR. KEITH V BJORGE
Credential : PSYD
Telephone Number : 815-578-4222
Provider Enumeration Date : 11/07/2006
Last Update Date : 11/10/2011

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