Provider Demographics
NPI:1992317358
Name:BERGLUND, MADISON MCHENRY
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MCHENRY
Last Name:BERGLUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9197 GRANT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4331
Mailing Address - Country:US
Mailing Address - Phone:303-450-3690
Mailing Address - Fax:303-962-1511
Practice Address - Street 1:9197 GRANT ST STE 100
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4331
Practice Address - Country:US
Practice Address - Phone:303-450-3690
Practice Address - Fax:303-962-1511
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6328208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics