Healthcare Provider Details

I. General information

NPI: 1053572578
Provider Name (Legal Business Name): CAROL LYNN BERSETH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PARK PLAZA DR
EVANSVILLE IN
47715-3632
US

IV. Provider business mailing address

401 PARK PLAZA DR
EVANSVILLE IN
47715-3632
US

V. Phone/Fax

Practice location:
  • Phone: 812-471-8984
  • Fax:
Mailing address:
  • Phone: 812-471-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01056952A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: