Healthcare Provider Details

I. General information

NPI: 1548973126
Provider Name (Legal Business Name): ALLEN PRAXIDIO BERGSTEDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15870 FARNHAM AVE N
HUGO MN
55038-9002
US

IV. Provider business mailing address

15870 FARNHAM AVE N
HUGO MN
55038-9002
US

V. Phone/Fax

Practice location:
  • Phone: 612-442-3996
  • Fax: 612-473-6277
Mailing address:
  • Phone: 612-442-3996
  • Fax: 612-473-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number78163
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number78163
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: