Healthcare Provider Details

I. General information

NPI: 1417336090
Provider Name (Legal Business Name): BERTON HEATON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5124 SHERIDAN AVE S
MINNEAPOLIS MN
55410-2237
US

IV. Provider business mailing address

5124 SHERIDAN AVE S
MINNEAPOLIS MN
55410-2237
US

V. Phone/Fax

Practice location:
  • Phone: 952-240-9342
  • Fax:
Mailing address:
  • Phone: 952-240-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number67208
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: