Provider Demographics
NPI:1952403818
Name:BERGER, MARCIE G (MD)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:G
Last Name:BERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:ELECTROPHYSIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6204
Mailing Address - Fax:414-805-6280
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:ELECTROPHYSIOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6204
Practice Address - Fax:414-805-6280
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34483-020207RC0001X
IL036-105281207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
32637500OtherMANAGED HEALTH SERVICES
1473529OtherCIGNA
WI32637500OtherNETWORK HEALTH T19
7782095OtherAETNA
WI1135 73-601Medicaid
32637500OtherABRI HEALTHCARE T19
WI1952403818Medicaid
32637500OtherAMERICHOICE T19
WI32637500OtherINDEPENDENT CARE ICARE
WI1135 73-601Medicaid
32637500OtherAMERICHOICE T19
000002535-0003Medicare ID - Type UnspecifiedMILWAUKEE COUNTY
32637500OtherMANAGED HEALTH SERVICES
P00258579Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI1952403818Medicaid