MEDICARE: DR. LEWIS HERMAN BERGER M.D.

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	208200000X	Plastic Surgery Physician	ME21219	FL

General Provider Information

NPI Number	:	1134130016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEWIS HERMAN BERGER M.D.

Provider Business Mailing Address
First Line	:	2901 W SAINT ISABEL ST
Second Line	:	SUITE 2C
City	:	TAMPA
State	:	FL
Zip	:	33607-6371
Country	:	US
Telephone Number	:	813-877-7658
Fax Number	:	813-872-8305

Provider Business Practice Location Address
First Line	:	2901 W SAINT ISABEL ST
Second Line	:	SUITE 2C
City	:	TAMPA
State	:	FL
Zip	:	33607-6371
Country	:	US
Telephone Number	:	813-877-7658
Fax Number	:	813-872-8305

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	08/22/2011

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