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General NPI Number Information
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NPI Number | 1780646588
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Entity Type | Individual
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Provider Name | JOHN LOUIS BERGE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 7600 FRANCE AVE S STE 4100
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City | EDINA
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State | MN
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Zip | 55435
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Country | US
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Telephone | 952-831-1551
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Fax | 952-831-0725
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Provider Business Mailing Address
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Address Line | 7250 FRANCE AVE S STE 410
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City | EDINA
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State | MN
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Zip | 55435-4314
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Country | US
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Telephone | 952-831-1551
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Fax | 952-831-0725
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 43858
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License Number State | MN
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