Healthcare Provider Details

I. General information

NPI: 1336433192
Provider Name (Legal Business Name): JEANNETTE ZINGGELER BERG MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 378
COEUR D ALENE ID
83814-4401
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 208-765-1252
  • Fax: 208-765-1494
Mailing address:
  • Phone: 86-255-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberM-13711
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberM-13711
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: