Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 125052989 | IL |
N | 207XS0106X | Orthopaedic Hand Surgeon | 60479-20 | WI |
Y | 2086S0105X | Surgery of the Hand | 60479 | WI |
NPI | 1720244288 |
---|---|
Provider Name | Dr. John C Berschback |
First Address | Altoona, WI 54720-2245 |
Second Address | Altoona, WI 54720-2245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01307815 | RAILROAD MEDICARE (01) | WI |