Individual
LISA A BERGERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11115 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 266-5400
(260) 266-5405
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01043876A
IN
208000000X
Pediatrics Physician
35065206
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000602350
ANTHEM
IN
05
—
200037410
—
IN
Enumeration date
06/10/2005
Last updated
12/20/2022
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