Individual
RICHARD C BERG JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2479
(765) 448-8000
(765) 448-8027
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01056973A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000248484
ANTHEM PROVIDER NUMBER
IN
01
—
10923010
CAQH NUMBER
IN
05
—
200402790
—
IN
01
—
467264
PHCS PID NUMBER
IN
01
—
G34750
MEDICARE UPIN NUMBER
IN
Enumeration date
03/15/2006
Last updated
02/01/2021
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