Provider Demographics
NPI:1124004551
Name:DR. GARY BERGER, PA
Entity Type:Organization
Organization Name:DR. GARY BERGER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:913-339-9550
Mailing Address - Street 1:5701 W 119TH ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3722
Mailing Address - Country:US
Mailing Address - Phone:913-339-9550
Mailing Address - Fax:913-339-9679
Practice Address - Street 1:5701 W 119TH ST
Practice Address - Street 2:SUITE 116
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3722
Practice Address - Country:US
Practice Address - Phone:913-339-9550
Practice Address - Fax:913-339-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-18
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0524221208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS458375OtherBC OF KS
220400900OtherUS DEPT OF LABOR
P00060824OtherRAILROAD MEDICARE
18688071OtherBC/BS OF KC
P00060824OtherRAILROAD MEDICARE
220400900OtherUS DEPT OF LABOR