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General NPI Number Information
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NPI Number | 1780986034
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Entity Type | Organization
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Legal Business Name | BERGMAN INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 3079 E COMMERCIAL BLVD SUITE 201
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4311
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Country | US
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Telephone | 954-551-1243
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Fax | 954-200-7809
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Provider Business Mailing Address
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Address Line | 3079 E COMMERCIAL BLVD SUITE 201
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4311
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Country | US
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Telephone | 954-551-1243
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Fax | 954-200-7809
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Authorized Official
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Title or Position | CEO
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Name | DR. MARY LEE BERGMAN
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Credential | DOM
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Telephone | 954-551-1243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP 404
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License Number State | FL
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