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General NPI Number Information
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NPI Number | 1215462940
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Entity Type | Individual
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Provider Name | JORDAN L BERG MD
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Gender | Female
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 209 9TH ST STE 200
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City | ROCKFORD
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State | IL
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Zip | 61104-2235
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Country | US
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Telephone | 779-696-2750
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Fax | 779-696-4196
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Provider Business Mailing Address
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Address Line | 3200 E RACINE ST
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City | JANESVILLE
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State | WI
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Zip | 53546-2343
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Country | US
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Telephone | 608-371-8000
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Fax | 608-371-8927
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 75817
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License Number State | WI
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