Healthcare Provider Details

I. General information

NPI: 1558299289
Provider Name (Legal Business Name): KACI BERGMAN B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3769 QUARTON RD # MI
BLOOMFIELD HILLS MI
48302-4058
US

IV. Provider business mailing address

11073 WATERPOINT DR
ALLENDALE MI
49401-9666
US

V. Phone/Fax

Practice location:
  • Phone: 248-894-1966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: