Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 036-097991 | IL |
NPI | 1205880820 |
---|---|
Provider Name | Christopher J Bergin |
First Address | Park Ridge, IL 60068-1129 |
Second Address | Park Ridge, IL 60068-1129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 06/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-097991 | (05) | IL |
H01135 | (02) | IL |