Provider Demographics
NPI:1679788772
Name:BERNER-HOLMBERG, LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:
Last Name:BERNER-HOLMBERG
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 1:130 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60040-1122
Mailing Address - Country:US
Mailing Address - Phone:847-909-2004
Mailing Address - Fax:847-433-8906
Practice Address - Street 1:130 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HIGHWOOD
Practice Address - State:IL
Practice Address - Zip Code:60040-1122
Practice Address - Country:US
Practice Address - Phone:847-909-2004
Practice Address - Fax:847-266-0961
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082171207Q00000X
IL036-082171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082171Medicaid
IL111313752902Medicare PIN