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NPI Code Detail

MEDICARE: WILLIAM J BERGHOFF MD

MEDICARE: WILLIAM J BERGHOFF 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
1207X00000XOrthopaedic Surgery Physician01036245AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1200012341OTHERINRAIL ROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1811995970
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM J BERGHOFF MD
Provider Business Mailing Address
First Line : 5052 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5822
Country : US
Telephone Number : 260-484-8551
Fax Number : 260-482-5060
Provider Business Practice Location Address
First Line : 5050 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5886
Country : US
Telephone Number : 260-484-8551
Fax Number : 260-484-9603
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 10/19/2018

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Directions to “ WILLIAM J BERGHOFF MD” Practice Location

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