MEDICARE: BARRY W BERGER D.O.

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	207R00000X	Internal Medicine Physician	036062693	IL

General Provider Information

NPI Number	:	1770634560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY W BERGER D.O.

Provider Business Mailing Address
First Line	:	4626 N BORGATELLO LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3002
Country	:	US
Telephone Number	:	480-661-4800
Fax Number	:	602-368-9002

Provider Business Practice Location Address
First Line	:	290 N RAND RD
Second Line	:	SUITE A
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2213
Country	:	US
Telephone Number	:	847-438-2454
Fax Number	:	847-438-2462

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	08/09/2017

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