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General NPI Number Information
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NPI Number | 1629391776
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Entity Type | Organization
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Legal Business Name | MARK D. BERGER, M.D., S.C.
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE STE 901
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City | CHICAGO
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State | IL
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Zip | 60602-3767
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Country | US
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Telephone | 312-782-0292
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N MICHIGAN AVE SUITE 901
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City | CHICAGO
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State | IL
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Zip | 60602-3767
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Country | US
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Telephone | 312-782-0292
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK DAVE BERGER
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Credential | M.D.
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Telephone | 312-782-0292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 3636630
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 042.000349036.033630
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License Number State | IL
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