Healthcare Provider Details

I. General information

NPI: 1457005084
Provider Name (Legal Business Name): INTERVENTIONAL ORTHOPEDIC SOLUTIONS-ROCHESTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 2ND ST SW SUITE 120
ROCHESTER MN
55902-4432
US

IV. Provider business mailing address

5287 SCENIC VIEW DR SW
ROCHESTER MN
55902
US

V. Phone/Fax

Practice location:
  • Phone: 507-361-0400
  • Fax: 866-371-6710
Mailing address:
  • Phone: 507-721-9758
  • Fax: 866-371-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL A BERGUM
Title or Position: OWNER
Credential: DO
Phone: 507-251-5870