Individual
DR. DONNA C BERGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1725 W HARRISON ST, 1106, CHICAGO, IL 60612-3841
(312) 942-5936
Mailing address
1725 W HARRISON ST, 1106, CHICAGO, IL 60612-3841
(312) 942-4500
(312) 942-2380
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036045728
IL
2084N0600X
Clinical Neurophysiology Physician
036045728
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036045728
—
IL
01
—
336012506
CONTROLLED
IL
Enumeration date
09/27/2005
Last updated
03/07/2023
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