Individual
JOHN W BERKENBOSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
231 E CHESTNUT ST, LOUISVILLE, KY 40202-1821
(502) 629-6000
(502) 629-5865
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 629-6000
(502) 629-5865
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
38590
KY
208000000X
Pediatrics Physician
38590
KY
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
38590
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200493520
—
IN
05
—
64090947
—
KY
Enumeration date
12/05/2005
Last updated
10/12/2020
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