Healthcare Provider Details

I. General information

NPI: 1336287093
Provider Name (Legal Business Name): SUZANNE BERGEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OGDEN AVE SUITE 107
AURORA IL
60504-7206
US

IV. Provider business mailing address

1256 WATERFORD DRIVE SUITE 230
AURORA IL
60504
US

V. Phone/Fax

Practice location:
  • Phone: 630-692-5700
  • Fax: 630-692-5750
Mailing address:
  • Phone: 630-499-2404
  • Fax: 630-499-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number036077003
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: