Provider Demographics
NPI:1003092792
Name:SANDRA M BERGLUND, DO, INC
Entity Type:Organization
Organization Name:SANDRA M BERGLUND, DO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-239-9077
Mailing Address - Street 1:18660 BAGLEY RD
Mailing Address - Street 2:BUILDING 1, SUITE 201
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3483
Mailing Address - Country:US
Mailing Address - Phone:440-239-9077
Mailing Address - Fax:440-239-9080
Practice Address - Street 1:18660 BAGLEY RD
Practice Address - Street 2:BUILDING 1, SUITE 201
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3483
Practice Address - Country:US
Practice Address - Phone:440-239-9077
Practice Address - Fax:440-239-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-13
Last Update Date:2008-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty