Provider Demographics
NPI:1922090794
Name:VAN DEN BERGHE, GREGORY R (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:R
Last Name:VAN DEN BERGHE
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 1:10777 NALL AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1330
Mailing Address - Country:US
Mailing Address - Phone:913-642-0200
Mailing Address - Fax:913-563-6699
Practice Address - Street 1:10777 NALL AVE STE 300
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1330
Practice Address - Country:US
Practice Address - Phone:913-642-0200
Practice Address - Fax:913-563-6699
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004010787207XX0005X
KS04-28403207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP0016511OtherRAILROAD MEDICARE
KSP0016511OtherRAILROAD MEDICARE
H85468Medicare UPIN
KS282D168AMedicare PIN