Provider Demographics
NPI:1760481253
Name:BERGLUND, ROBERT K (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:BERGLUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2501 CITICO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1127
Mailing Address - Country:US
Mailing Address - Phone:423-697-2000
Mailing Address - Fax:423-697-2118
Practice Address - Street 1:2051 HAMILL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-6606
Practice Address - Country:US
Practice Address - Phone:423-697-2000
Practice Address - Fax:423-697-2118
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN10706207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522811Medicaid
TNBO3460Medicare UPIN
TN1522811Medicaid