Basic Information
Provider Information
NPI: 1003014911
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BERGER
FirstName: JOHN
MiddleName: PAUL
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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: 09/04/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X675NEN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X54798MNY Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X4095IAN Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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