MEDICARE: JEREMY S BERG D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	OS19796	FL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	OS19796	FL
3	207RP1001X	Pulmonary Disease Physician	036120085	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104095157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY S BERG D.O.

Provider Business Mailing Address
First Line	:	172 E SCHILLER ST
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-2816
Country	:	US
Telephone Number	:	630-941-2638
Fax Number	:

Provider Business Practice Location Address
First Line	:	5430 LINTON BLVD
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6512
Country	:	US
Telephone Number	:	847-386-7744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	12/20/2023

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