Healthcare Provider Details

I. General information

NPI: 1851504518
Provider Name (Legal Business Name): JOSHUA BRADLEY BERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 N MERIDIAN ST STE 200
CARMEL IN
46032-1680
US

IV. Provider business mailing address

11455 N MERIDIAN ST STE 200
CARMEL IN
46032-1680
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberM9854
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01091787A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: