Individual
KELLE BERGGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
199 TOWN SQUARE, STE A, WHEATON, IL 60187
(630) 871-6690
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036108970
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036108970
—
IL
01
—
P00100007
RR MEDICARE
IL
Enumeration date
01/05/2006
Last updated
08/04/2023
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