Healthcare Provider Details

I. General information

NPI: 1215400031
Provider Name (Legal Business Name): PHILIP C BERCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 S 6TH ST
OAK CREEK WI
53154-2010
US

IV. Provider business mailing address

7901 S 6TH ST
OAK CREEK WI
53154-2010
US

V. Phone/Fax

Practice location:
  • Phone: 414-346-8000
  • Fax: 414-346-8010
Mailing address:
  • Phone: 414-346-8000
  • Fax: 414-346-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17959-40
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number84455-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: