Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 01045293A | IN |
N | 207PE0004X | Emergency Medical Services | 01045293 | IN |
NPI | 1043210180 |
---|---|
Provider Name | Dawn M Detwiler Berger |
First Address | Elkhart, IN 46514-1228 |
Second Address | Middlebury, IN 46540-8608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 02/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200123720 | (05) | IN |
G62654 | (02) |