MEDICARE: DR KERRY E BERG LLC

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1457162174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR KERRY E BERG LLC

Provider Business Mailing Address
First Line	:	8340 RUSSETT CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-4504
Country	:	US
Telephone Number	:	719-660-4390
Fax Number	:

Provider Business Practice Location Address
First Line	:	8340 RUSSETT CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-4504
Country	:	US
Telephone Number	:	719-660-4390
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KERRY BERG
Credential	:
Telephone Number	:	719-660-4390

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	01/14/2025

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