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NPI Code Detail

MEDICARE: KEVIN L BERGER M.D.

MEDICARE: KEVIN L 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
1208000000XPediatrics Physician26170AZ

General Provider Information

NPI Number : 1396780755
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN L BERGER M.D.
Provider Business Mailing Address
First Line : 4434 N 12TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-4507
Country : US
Telephone Number : 602-242-5121
Fax Number : 602-242-6945
Provider Business Practice Location Address
First Line : 4434 N 12TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-4507
Country : US
Telephone Number : 602-242-5121
Fax Number : 602-242-6945
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2006
Last Update Date : 01/19/2024

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Directions to “ KEVIN L BERGER M.D.” Practice Location

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