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Individual

BETH A. BERGMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2901 GREENBRIAR DR, SPRINGFIELD, IL 62704-6425
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036-080163
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036080163
IL
Enumeration date
08/30/2006
Last updated
12/05/2008
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