Healthcare Provider Details

I. General information

NPI: 1811948268
Provider Name (Legal Business Name): STUART BERGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 21
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE # 21
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 414-491-6739
  • Fax:
Mailing address:
  • Phone: 441-449-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number31753
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number036-061898
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: