Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

MS. Mallorie A Bergstrom, PA-C

Individual provider Physician Assistant · NPI 1730490012

MS. Mallorie A Bergstrom, PA-C is a Physician Assistant in Wauwatosa, Wisconsin. Qualified in 2010, 16 years ago. Practices with Premier Radiology Wisconsin LLC, a 111-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
16
Licensed in
WI
In the registry since
2010
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

2727 N Mayfair Rd Ste I
Wauwatosa, WI 53222-4400
Phone: (414) 727-0910
Fax: (414) 727-0920
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 2591-23 (WI)

Record details

NPI number1730490012
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 1, 2010
Last updated in NPPESMay 2, 2022
Certification dateMay 2, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Premier Radiology Wisconsin Llc — 111 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations8 on file with Medicare

Other providers in Wauwatosa