Provider Demographics
NPI:1962791657
Name:MARSHALL-BERGMAN, BETH M (DO)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:M
Last Name:MARSHALL-BERGMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:M
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 S MAPLE AVE
Mailing Address - Street 2:SUITE 4600
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 S MAPLE AVE
Practice Address - Street 2:SUITE 4600
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1091
Practice Address - Country:US
Practice Address - Phone:708-660-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.135673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine