Provider Demographics
NPI:1851395578
Name:BERKENBILE, DAVID A (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:BERKENBILE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 APEX DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1285
Mailing Address - Country:US
Mailing Address - Phone:618-651-2727
Mailing Address - Fax:618-654-7905
Practice Address - Street 1:30 APEX DR
Practice Address - Street 2:SUITE 2
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1285
Practice Address - Country:US
Practice Address - Phone:618-651-2727
Practice Address - Fax:618-654-7905
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006018663207Q00000X
IL036073061207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1851395578Medicaid
IL036073061-2Medicaid
AZD16494Medicare UPIN
IL036073061-2Medicaid
ILIL1682023Medicare PIN
ILIL1682054Medicare PIN