Individual
CHARLES P. BERGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9000 W WISCONSIN AVE, PEDIATRIC CRITICAL CARE, MILWAUKEE, WI 53226-4874
(414) 266-3360
(414) 266-3563
Mailing address
9000 W WISCONSIN AVE, PEDIATRIC CRITICAL CARE, MILWAUKEE, WI 53226-4874
(414) 266-3360
(414) 266-3563
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
248026
NY
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
65736
WI
208M00000X
Hospitalist Physician
248026
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A878510
—
CA
05
—
02961219
—
NY
05
—
1225059421
—
WI
Enumeration date
07/22/2006
Last updated
01/29/2021
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