Healthcare Provider Details

I. General information

NPI: 1730116518
Provider Name (Legal Business Name): DEBRA C BERGMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12425 OLD MERIDIAN ST SUITE #B1
CARMEL IN
46032-8724
US

IV. Provider business mailing address

PO BOX 68952
INDIANAPOLIS IN
46268-0952
US

V. Phone/Fax

Practice location:
  • Phone: 317-581-0001
  • Fax: 317-581-0002
Mailing address:
  • Phone: 317-802-3158
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number01045277A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: