MEDICARE: MICHAEL E. BERGER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	LP 1910	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841347085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL E. BERGER PA

Provider Business Mailing Address
First Line	:	5353 GAMBLE DR
Second Line	:	SUITE 160
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1509
Country	:	US
Telephone Number	:	952-929-2276
Fax Number	:	952-929-8576

Provider Business Practice Location Address
First Line	:	5353 GAMBLE DR
Second Line	:	SUITE 160
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1509
Country	:	US
Telephone Number	:	952-929-2276
Fax Number	:	952-929-8576

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. MICHAEL BERGER
Credential	:	PHD, LP
Telephone Number	:	952-929-2276

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	06/26/2014

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