Healthcare Provider Details

I. General information

NPI: 1720168024
Provider Name (Legal Business Name): PROPONENT MEDICAL GROUP,LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 ROYAL BLVD SUITE 500
ELGIN IL
60123-4719
US

IV. Provider business mailing address

2350 ROYAL BLVD SUITE 500
ELGIN IL
60123-4719
US

V. Phone/Fax

Practice location:
  • Phone: 847-697-3800
  • Fax: 847-697-3804
Mailing address:
  • Phone: 847-697-3800
  • Fax: 847-697-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number042617550
License Number StateIL

VIII. Authorized Official

Name: DR. LAWRENCE F BERG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-697-3800