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General NPI Number Information
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NPI Number | 1548973126
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Entity Type | Individual
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Provider Name | ALLEN PRAXIDIO BERGSTEDT MD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 04/13/2025
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Provider Practice Location Address
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Address Line | 13819 HANSON BLVD NW
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City | ANDOVER
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State | MN
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Zip | 55304-7608
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Country | US
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Telephone | 612-442-3996
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Fax |
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Provider Business Mailing Address
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Address Line | 15870 FARNHAM AVE N
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City | HUGO
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State | MN
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Zip | 55038-9002
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Country | US
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Telephone | 612-442-3996
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 78163
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License Number State | MN
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