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General NPI Number Information
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NPI Number | 1528064227
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Entity Type | Individual
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Provider Name | MELANIE L BERG D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 403 STAGELINE RD
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City | HUDSON
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State | WI
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Zip | 54016-7848
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Country | US
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Telephone | 715-531-6800
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Fax | 715-531-6801
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Provider Business Mailing Address
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Address Line | 5803 NEAL AVE N
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City | OAK PARK HEIGHTS
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State | MN
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Zip | 55082-2177
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Country | US
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Telephone | 651-439-8807
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Fax | 651-439-0232
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 861-025
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 710
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License Number State | MN
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