Individual
STEPHEN HENRY BERGHOFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
112 S HARRISON ST, ALEXANDRIA, IN 46001-2067
(765) 724-7627
Mailing address
10330 N MERIDIAN ST, SUITE 201, INDIANAPOLIS, IN 46290-1024
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01043612A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
01043612A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200062200
—
IN
01
—
DC3600
RAILROAD GROUP
IN
01
—
P00616368
RAILROAD INDIVIDUAL
IN
Enumeration date
11/23/2005
Last updated
10/03/2008
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