Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 036077003 | IL |
NPI | 1336287093 |
---|---|
Provider Name | Suzanne Bergen |
First Address | Aurora, IL 60504 |
Second Address | Aurora, IL 60504-7206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 10/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-077003 | (05) | IL |