Provider Demographics
NPI:1407881931
Name:BERGQUIST, STEVEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:BERGQUIST
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 1:7080 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3838
Mailing Address - Country:US
Mailing Address - Phone:414-351-4009
Mailing Address - Fax:414-351-7060
Practice Address - Street 1:7080 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3838
Practice Address - Country:US
Practice Address - Phone:414-351-4009
Practice Address - Fax:414-351-7060
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34452207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31970800Medicaid
WI31970800Medicaid
WI31970800Medicaid
E46382Medicare UPIN