Basic Information
| Provider Information | |||||||||
| NPI: | 1043219736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERG | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6002 | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618036002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173268630 | ||||||||
| FaxNumber: | 6153093338 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 W. FAIRCHILD | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618323876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174317650 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 12/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 38999 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036133526 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.