Provider Demographics
NPI:1336403336
Name:BERGMAN, ANNAMARIE CHRISTINE (MED)
Entity type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:CHRISTINE
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1434
Mailing Address - Country:US
Mailing Address - Phone:847-845-3961
Mailing Address - Fax:
Practice Address - Street 1:202 ROYAL CT
Practice Address - Street 2:
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-1434
Practice Address - Country:US
Practice Address - Phone:847-845-3961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist