Provider Demographics
NPI:1992773691
Name:BERGE, LISBETH K (MD)
Entity type:Individual
Prefix:
First Name:LISBETH
Middle Name:K
Last Name:BERGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 UNIVERSITY LAKE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4658
Mailing Address - Country:US
Mailing Address - Phone:907-777-1850
Mailing Address - Fax:855-468-1357
Practice Address - Street 1:3801 UNIVERSITY WAY DR.
Practice Address - Street 2:SUITE 301
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-777-1850
Practice Address - Fax:907-777-1800
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3927207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK152556OtherMCARE
AKMD03282Medicaid
AK3927OtherAK STATE MEDICAL LICENSE
AKMD03282Medicaid