MEDICARE: JOSEPH BERGS M.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
1	2084P0800X	Psychiatry Physician	30186	WI

General Provider Information

NPI Number	:	1922038900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH BERGS M.D.

Provider Business Mailing Address
First Line	:	3805B SPRING ST
Second Line	:	SUITE 240
City	:	RACINE
State	:	WI
Zip	:	53405-1641
Country	:	US
Telephone Number	:	262-687-8108
Fax Number	:	262-687-8109

Provider Business Practice Location Address
First Line	:	3805B SPRING ST
Second Line	:	SUITE 240
City	:	RACINE
State	:	WI
Zip	:	53405-1641
Country	:	US
Telephone Number	:	262-687-8108
Fax Number	:	262-687-8109

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	09/16/2010

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