Healthcare Provider Details

I. General information

NPI: 1720244288
Provider Name (Legal Business Name): JOHN C BERSCHBACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OAKLEAF WAY SUITE A
ALTOONA WI
54720-2245
US

IV. Provider business mailing address

1200 OAKLEAF WAY SUITE A
ALTOONA WI
54720-2245
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-1400
  • Fax: 715-832-4187
Mailing address:
  • Phone: 715-832-1400
  • Fax: 715-832-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number125052989
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number60479-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number60479
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: