Provider Demographics
NPI:1881752178
Name:BERG, SANDRA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:BERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:ELIZABETH
Other - Last Name:RAIMONDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1472 W BELLE PLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1902
Mailing Address - Country:US
Mailing Address - Phone:773-929-1631
Mailing Address - Fax:
Practice Address - Street 1:7464 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1620
Practice Address - Country:US
Practice Address - Phone:847-316-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology