Provider Demographics
NPI:1437152642
Name:BERG, DONALD D (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:D
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 1:1005 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 212
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6414
Mailing Address - Country:US
Mailing Address - Phone:641-682-5443
Mailing Address - Fax:641-682-6859
Practice Address - Street 1:1005 PENNSYLVANIA AVE
Practice Address - Street 2:STE 212
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6414
Practice Address - Country:US
Practice Address - Phone:641-682-5443
Practice Address - Fax:641-682-6859
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2009-12-17
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
IA18416207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0122879Medicaid
IAS52701OtherJOHN DEERE HEALTHCARE
IA12287OtherWELLMARK BLUE CROSS BLUE
IAA01075Medicare UPIN
IA203918035Medicare PIN
IA12287OtherWELLMARK BLUE CROSS BLUE