Provider Demographics
NPI:1376506022
Name:BERG, JEFFREY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:BERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE 2211
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1444
Mailing Address - Country:US
Mailing Address - Phone:502-635-2775
Mailing Address - Fax:502-371-0475
Practice Address - Street 1:1169 EASTERN PKWY STE 2211
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1444
Practice Address - Country:US
Practice Address - Phone:502-635-2775
Practice Address - Fax:502-371-0475
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22581208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY164269100OtherDEPT OF LABOR
KY4466067OtherAETNA
KY64225816Medicaid
KY731879OtherFIRST HEALTH WORKMANS COM
KY9237372003OtherCIGNA
KY050071439OtherMEDICARE RR
KYPASSPORTOtherPASSPORT
KY000000112276OtherBC/BS
KY2436583000OtherPASSPORT ADVANATGE
KY64225816Medicaid
KYPASSPORTOtherPASSPORT