Provider Demographics
NPI:1134130016
Name:BERGER, LEWIS HERMAN (MD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:HERMAN
Last Name:BERGER
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 1:2901 W SAINT ISABEL ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6371
Mailing Address - Country:US
Mailing Address - Phone:813-877-7658
Mailing Address - Fax:813-872-8305
Practice Address - Street 1:2901 W SAINT ISABEL ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6371
Practice Address - Country:US
Practice Address - Phone:813-877-7658
Practice Address - Fax:813-872-8305
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME21219208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD53820Medicare UPIN
FL29993Medicare ID - Type Unspecified