Healthcare Provider Details

I. General information

NPI: 1902181316
Provider Name (Legal Business Name): JESSICA MICHELE BERGMANN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MICHELE GREGG

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 GROSS POINT RD.
SKOKIE IL
60076-1214
US

IV. Provider business mailing address

2650 RIDGE AVE. DEPARTMENT OF ANESTHESIA
EVANSTON IL
60201
US

V. Phone/Fax

Practice location:
  • Phone: 847-945-7246
  • Fax:
Mailing address:
  • Phone: 847-570-2760
  • Fax: 847-570-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085004188
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: