Provider Demographics
NPI:1316099849
Name:BERGER, RODNEY H (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:H
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 1:240 E LAKE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2890
Mailing Address - Country:US
Mailing Address - Phone:630-941-9344
Mailing Address - Fax:630-941-1486
Practice Address - Street 1:240 E LAKE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2890
Practice Address - Country:US
Practice Address - Phone:630-941-9344
Practice Address - Fax:630-941-1486
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063572174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063572Medicaid
ILD15312Medicare UPIN
IL036063572Medicaid