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NPI Code Detail

MEDICARE: DR. KEITH V BJORGE PSY D

MEDICARE:  DR. KEITH V BJORGE  PSY 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
1103TC0700XClinical Psychologist071-005483IL

General Provider Information

NPI Number : 1700053360
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH V BJORGE PSY D
Provider Business Mailing Address
First Line : 61 S OLD RAND RD
Second Line :
City : LAKE ZURICH
State : IL
Zip : 60047-3127
Country : US
Telephone Number : 847-438-4222
Fax Number :
Provider Business Practice Location Address
First Line : 61 S OLD RAND RD
Second Line :
City : LAKE ZURICH
State : IL
Zip : 60047-3127
Country : US
Telephone Number : 847-438-4222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2008
Last Update Date : 05/13/2008

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Directions to “ DR. KEITH V BJORGE PSY D” Practice Location

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