| Doctor Name: | DANIELLE KUSSEROW BERSABE |
| NPI Number: | 1003177593 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 0101255839 |
| Business Practice Address: | 2200 Bergquist Dr Wilford Hall Ambulatory Surgical Center Lackland A F B, TX - 782369907 |
| Business Phone Number: | 2102927805 |
| Business Fax Number: | 2102927868 |
| Mailing Address: | 2200 Berquist Dr, Internal Medicine Clinic LACKLAND AFB |
| State: | TX |
| Postal Code: | 78233 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/31/2012 |
| NPI Last Update Date: | 10/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101255839 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |