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General NPI Number Information
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NPI Number | 1649666751
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Entity Type | Individual
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Provider Name | ERIK GUNNAR BERGERSEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 2900 W OKLAHOMA AVE
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City | MILWAUKEE
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State | WI
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Zip | 53215-4330
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Country | US
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Telephone | 414-649-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 W FOREST HOME AVE
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City | MILWAUKEE
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State | WI
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Zip | 53215-2843
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Country | US
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Telephone | 414-389-2377
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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 | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 35.135014
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.135014
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 73077
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License Number State | WI
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