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General NPI Number Information
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NPI Number | 1720168024
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Entity Type | Organization
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Legal Business Name | PROPONENT MEDICAL GROUP,LTD
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 2350 ROYAL BLVD SUITE 500
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City | ELGIN
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State | IL
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Zip | 60123-4719
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Country | US
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Telephone | 847-697-3800
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Fax | 847-697-3804
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Provider Business Mailing Address
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Address Line | 2350 ROYAL BLVD SUITE 500
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City | ELGIN
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State | IL
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Zip | 60123-4719
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Country | US
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Telephone | 847-697-3800
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Fax | 847-697-3804
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE F BERG
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Credential | M.D.
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Telephone | 847-697-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 042617550
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License Number State | IL
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