Basic Information
| Provider Information | |||||||||
| NPI: | 1851395578 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERKENBILE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 APEX DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | HIGHLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622491285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186512727 | ||||||||
| FaxNumber: | 6186547905 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 APEX DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | HIGHLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622491285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186512727 | ||||||||
| FaxNumber: | 6186547905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 06/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2006018663 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 036073061 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 036073061 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1851395578 | 05 | MO | MEDICAID | 036073061-2 | 05 | IL | MEDICAID |