Healthcare Provider Details

I. General information

NPI: 1518958214
Provider Name (Legal Business Name): JOHN HOWARD BERG JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

307 9TH ST SE
NEW PRAGUE MN
56071-1641
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18675
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number18675
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: