Provider Demographics
NPI:1518136993
Name:PAUL A BERGFELDER MD LLC
Entity Type:Organization
Organization Name:PAUL A BERGFELDER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BERGFELDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-935-2567
Mailing Address - Street 1:1915 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1281
Mailing Address - Country:US
Mailing Address - Phone:765-935-2567
Mailing Address - Fax:765-962-0880
Practice Address - Street 1:1915 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1281
Practice Address - Country:US
Practice Address - Phone:765-935-2567
Practice Address - Fax:765-962-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201063810AMedicaid
OH0062146Medicaid
INDS6966Medicare PIN
INM100060795Medicare PIN