Provider Demographics
NPI:1740216845
Name:BERG, TROY LYMAN (MD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:LYMAN
Last Name:BERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 OAKLEAF WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2245
Mailing Address - Country:US
Mailing Address - Phone:715-832-1400
Mailing Address - Fax:715-832-4187
Practice Address - Street 1:1200 OAKLEAF WAY
Practice Address - Street 2:SUITE A
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2245
Practice Address - Country:US
Practice Address - Phone:715-832-1400
Practice Address - Fax:715-832-4187
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI39869207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32440300Medicaid
WI5725706OtherAETNA
WI54456OtherSECURITY HEALTH PLAN
WI1852957OtherUNITED HEALTHCARE
WI09 07598OtherMEDICA/SELECTCARE EC
WI378L5BEOtherBCBS MN
WI09-07599OtherMEDICA/SELECTCARE CF
WI137616600OtherOWCP
WIP00171099OtherRAILROAD
WIP00171099OtherRAILROAD
WI09-07599OtherMEDICA/SELECTCARE CF
WI137616600OtherOWCP
WI000320325Medicare PIN