Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 036086664 | IL |
NPI | 1003816323 |
---|---|
Provider Name | Dr. Christopher D. Berg |
First Address | Hinsdale, IL 60521-3339 |
Second Address | Joliet, IL 60435-8200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 08/07/2007 |