Provider Demographics
NPI:1144617663
Name:BERGHOFF, AMY (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BERGHOFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3329
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-0329
Mailing Address - Country:US
Mailing Address - Phone:219-924-3300
Mailing Address - Fax:219-934-2658
Practice Address - Street 1:9900 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4008
Practice Address - Country:US
Practice Address - Phone:219-924-3300
Practice Address - Fax:219-934-2658
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001814A363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical