Provider Demographics
NPI:1568482214
Name:BERGER, ISRAEL (MD)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:BERGER
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 1:9669 KENTON AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1266
Mailing Address - Country:US
Mailing Address - Phone:847-329-0900
Mailing Address - Fax:847-679-3817
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:847-329-0900
Practice Address - Fax:847-679-3817
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047464208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047464Medicaid
ILC38514Medicare UPIN
IL036047464Medicaid