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NPI Code Detail

MEDICARE: DR. LISA MARIE BERGLUND MD

MEDICARE: DR. LISA MARIE BERGLUND MD
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
1207XP3100XPediatric Orthopaedic Surgery Physician2010004019MO

General Provider Information

NPI Number : 1417178369
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA MARIE BERGLUND MD
Provider Business Mailing Address
First Line : 2401 GILLHAM RD
Second Line : ROOM 2501.12 DIVISION OF ORTHOPAEDIC SURGERY
City : KANSAS CITY
State : MO
Zip : 64108-4619
Country : US
Telephone Number : 816-234-3693
Fax Number : 816-855-1993
Provider Business Practice Location Address
First Line : 2401 GILLHAM RD
Second Line : ROOM 2501.12 DIVISION OF ORTHOPAEDIC SURGERY
City : KANSAS CITY
State : MO
Zip : 64108-4619
Country : US
Telephone Number : 816-234-3693
Fax Number : 816-855-1993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 09/15/2011

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Directions to “ DR. LISA MARIE BERGLUND MD” Practice Location

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