Provider Demographics
NPI:1700841210
Name:HOWELL-BERG, JILL S (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:HOWELL-BERG
Suffix:
Gender:F
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:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2051 CLEVIDENCE BLVD STE C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2278
Practice Address - Country:US
Practice Address - Phone:812-280-6623
Practice Address - Fax:812-666-7688
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36034208000000X
IN01058138A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY023379OtherSIHO / NCMA
KY7100469040Medicaid
ININ4465039OtherMEDICARE
IN200442770Medicaid
KY000023031NOtherHUMANA / NCMA
KY1198868OtherCHA / NCMA
KYK266460OtherMEDICARE
KY000000299274OtherANTHEM / NCMA
KY6957640OtherCIGNA / NCMA