Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01055645A | IN |
Y | 208600000X | Surgeon | 01055645A | IN |
N | 2082S0105X | Plastic Hand Surgeon | 01055645A | IN |
NPI | 1164423620 |
---|---|
Provider Name | Kevin L Berning |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845-1715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104394511 | (05) | MI |
200377060 | (05) | IN |
H42359 | (02) | IN |