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General NPI Number Information
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NPI Number | 1013086792
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Entity Type | Organization
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Legal Business Name | DANIEL R BERG MD PC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2620 NORTH WALNUT STREET SUITE 400
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City | BLOOMINGTON
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State | IN
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Zip | 47404
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Country | US
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Telephone | 812-335-1824
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Fax | 812-335-1825
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Provider Business Mailing Address
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Address Line | 2620 NORTH WALNUT STREET SUITE 400
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City | BLOOMINGTON
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State | IN
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Zip | 47404
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Country | US
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Telephone |
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Fax | 812-335-1825
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL R BERG
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Credential | MD
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Telephone | 812-334-9158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01030985A
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License Number State | IN
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