Healthcare Provider Details

I. General information

NPI: 1982915120
Provider Name (Legal Business Name): LIISA L BERGMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W180N8085 TOWN HALL RD
MENOMONEE FALLS WI
53051-3518
US

IV. Provider business mailing address

W180N8085 TOWN HALL RD
MENOMONEE FALLS WI
53051-3518
US

V. Phone/Fax

Practice location:
  • Phone: 262-257-3060
  • Fax: 262-253-7197
Mailing address:
  • Phone: 262-257-3060
  • Fax: 262-253-7197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number69214-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number56555
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberS7008
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: