Organization
INTERNAL MEDICINE & AESTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE BERGMAN (AUTHORIZED OFFICIAL)
(765) 964-4100
Entity
Organization
Contact information
Practice address
6505 CONSTITUTION BLVD, PORTAGE, MI 49024-1604
(269) 599-8140
(269) 324-4329
Mailing address
PO BOX 443, UNION CITY, IN 47390-0443
(765) 964-4100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
03/11/2024
Last updated
03/11/2024
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