Provider Demographics
NPI:1831196815
Name:BERG, KERRY ELIZEBETH (DPM)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:ELIZEBETH
Last Name:BERG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9348 GRAND CORDERA PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924
Mailing Address - Country:US
Mailing Address - Phone:719-594-9920
Mailing Address - Fax:719-598-6212
Practice Address - Street 1:9348 GRAND CORDERA PKWY STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924
Practice Address - Country:US
Practice Address - Phone:719-594-9920
Practice Address - Fax:719-598-6212
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000518213ES0131X, 213E00000X
CO0000518213E00000X
CO517213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841087985OtherTAX ID
CO04532339Medicaid
CO517OtherSTATE LISCENSE
CO04532339Medicaid
CO841087985OtherTAX ID