Provider Demographics
NPI:1205059110
Name:BERGMANN, JOHN N (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
Last Name:BERGMANN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1657
Mailing Address - Country:US
Mailing Address - Phone:847-729-7923
Mailing Address - Fax:847-729-7944
Practice Address - Street 1:1860 JOHNS DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1657
Practice Address - Country:US
Practice Address - Phone:847-729-7923
Practice Address - Fax:847-729-7944
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001699003OtherBLUECROSSBLUESHIELD
IL0001699003OtherBLUECROSSBLUESHIELD