Healthcare Provider Details

I. General information

NPI: 1699984062
Provider Name (Legal Business Name): AMANDA LISA BERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N PINE ISLAND RD STE 200
PLANTATION FL
33324-1849
US

IV. Provider business mailing address

4780 SW 64TH AVE STE 103
DAVIE FL
33314-4400
US

V. Phone/Fax

Practice location:
  • Phone: 954-424-4321
  • Fax: 954-424-7702
Mailing address:
  • Phone: 954-434-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME101078
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: