MEDICARE: DR. KERRY ELIZEBETH BERG DPM

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	213ES0131X	Foot Surgery Podiatrist	POD.0000518	CO
2	213E00000X	Podiatrist	0000518	CO
3	213E00000X	Podiatrist	POD.0000518	CO
4	213ES0103X	Foot & Ankle Surgery Podiatrist	517	CO

General Provider Information

NPI Number	:	1831196815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY ELIZEBETH BERG DPM

Provider Business Mailing Address
First Line	:	9348 GRAND CORDERA PKWY
Second Line	:	STE 210
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924
Country	:	US
Telephone Number	:	719-594-9920
Fax Number	:	719-598-6212

Provider Business Practice Location Address
First Line	:	9348 GRAND CORDERA PKWY STE 210
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924
Country	:	US
Telephone Number	:	719-594-9920
Fax Number	:	719-598-6212

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	01/12/2025

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