Basic Information
| Provider Information | |||||||||
| NPI: | 1982780086 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERGIN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 LINWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544814428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153450799 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4005 COMMUNITY CENTER DR | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544764139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152415400 | ||||||||
| FaxNumber: | 7152415414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207V00000X | 19586-020 | WI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 30206100 | 05 | WI | MEDICAID |