Healthcare Provider Details

I. General information

NPI: 1639588023
Provider Name (Legal Business Name): ABIGAIL BERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CENTRAL RD SUITE 5300
ARLINGTON HEIGHTS IL
60005-2349
US

IV. Provider business mailing address

2650 WARRENVILLE RD SUITE 280
DOWNERS GROVE IL
60515-1748
US

V. Phone/Fax

Practice location:
  • Phone: 847-788-1553
  • Fax: 630-929-8096
Mailing address:
  • Phone: 630-324-7900
  • Fax: 630-929-8096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085005112
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: