Basic Information
| Provider Information | |||||||||
| NPI: | 1003014911 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERGER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3900 E 50TH ST | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554171674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022506427 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3100 KENNARD ST | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | MAPLEWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551095465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514711166 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 675 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 54798 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4095 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 54798 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.