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General NPI Number Information
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NPI Number | 1104803568
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Entity Type | Individual
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Provider Name | LARRY F BERGER MD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 7525 MITCHELL ROAD SUITE 200B
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-1957
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Country | US
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Telephone | 952-657-5452
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Fax | 952-657-5453
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Provider Business Mailing Address
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Address Line | 7525 MITCHELL ROAD SUITE 200B
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-1957
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Country | US
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Telephone | 952-657-5452
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Fax | 952-657-5453
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 29521
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License Number State | MN
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