Healthcare Provider Details

I. General information

NPI: 1245221647
Provider Name (Legal Business Name): MARK A BERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 1ST ST NE
NEW PRAGUE MN
56071-2215
US

IV. Provider business mailing address

580 RICE ST
SAINT PAUL MN
55103-2148
US

V. Phone/Fax

Practice location:
  • Phone: 952-758-2535
  • Fax: 952-548-6160
Mailing address:
  • Phone: 651-227-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number38780
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME174964
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38780
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number38780
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number38780
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number38780
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: