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NPI Code Detail

MEDICARE: MARK D. BERGER, M.D., S.C.

MEDICARE: MARK D. BERGER, M.D., S.C.
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
1102L00000XPsychoanalyst3636630IL
2102L00000XPsychoanalyst042.000349036.033630IL

General Provider Information

NPI Number : 1629391776
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARK D. BERGER, M.D., S.C.
Provider Business Mailing Address
First Line : 30 N MICHIGAN AVE
Second Line : SUITE 901
City : CHICAGO
State : IL
Zip : 60602-3767
Country : US
Telephone Number : 312-782-0292
Fax Number :
Provider Business Practice Location Address
First Line : 30 N MICHIGAN AVE STE 901
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3767
Country : US
Telephone Number : 312-782-0292
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARK DAVE BERGER
Credential : M.D.
Telephone Number : 312-782-0292
Provider Enumeration Date : 03/03/2010
Last Update Date : 04/14/2010

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