Louis William Bergman

Primary specialty

PharmacistTaxonomy code 183500000X

License

5302121230 Issued in MI

Practice address

3763 75 Business Spur
Sault Ste Marie, MI 49783

Phone

(906) 632-0582

Fax

(906) 632-0584

NPI assigned

Aug 28, 2019

Last updated

Aug 28, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566950400000",
    "number": "1033767512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2623 W 20TH ST",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497839478",
            "telephone_number": "906-203-4589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3763 75 BUSINESS SPUR",
            "city": "SAULT STE MARIE",
            "state": "MI",
            "postal_code": "49783",
            "telephone_number": "906-632-0582",
            "fax_number": "906-632-0584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGMAN",
        "first_name": "LOUIS",
        "middle_name": "WILLIAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-28",
        "last_updated": "2019-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302121230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER",
            "identifier": "5302121230",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bruce Alan Anderson II, DDS
• Melanie A Cook, OPTICAN HEARING AID
• Ralph J Duman, MD
• Heather Patricia Fasulo, RPH
• Great Lakes Recovery Centers
• Great Lakes Recovery Centers

• Pharmacist in Sault Ste Marie, MI
• Providers in Sault Ste Marie, MI by specialty
• Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.