Healthcare Provider Details

I. General information

NPI: 1336121938
Provider Name (Legal Business Name): MARK G BERRY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E SUPERIOR ST
DULUTH MN
55802-2207
US

IV. Provider business mailing address

800 KENYON RD
FORT DODGE IA
50501-5776
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-3057
  • Fax: 218-249-3091
Mailing address:
  • Phone: 515-574-6840
  • Fax: 515-576-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number73897
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: