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General NPI Number Information
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NPI Number | 1467847004
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Entity Type | Individual
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Provider Name | HANNAH JACQUELYN MILLER BERGMAN MD
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Gender | Female
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 3901 RAINBOW BLVD MS 3015
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City | KANSAS CITY
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State | KS
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Zip | 66160-8500
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Country | US
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Telephone | 715-853-2677
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 RAINBOW BLVD
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City | KANSAS CITY
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State | MO
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Zip | 64180-2843
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Country | US
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Telephone |
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Fax |
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 2022028794
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License Number State | MO
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