Healthcare Provider Details

I. General information

NPI: 1487888012
Provider Name (Legal Business Name): MICHAEL JOHN BERGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 69TH ST STE. 1500
SIOUX FALLS SD
57108-8170
US

IV. Provider business mailing address

2400 S. MINNESOTA AVE. STE. 100
SIOUX FALLS SD
57105-3762
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-5700
  • Fax: 605-322-5704
Mailing address:
  • Phone: 605-322-7510
  • Fax: 605-322-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number8908
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: