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General NPI Number Information
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NPI Number | 1841347085
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Entity Type | Organization
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Legal Business Name | MICHAEL E. BERGER PA
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 5353 GAMBLE DR SUITE 160
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-1509
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Country | US
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Telephone | 952-929-2276
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Fax | 952-929-8576
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Provider Business Mailing Address
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Address Line | 5353 GAMBLE DR SUITE 160
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-1509
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Country | US
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Telephone | 952-929-2276
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Fax | 952-929-8576
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. MICHAEL BERGER
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Credential | PHD, LP
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Telephone | 952-929-2276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP 1910
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License Number State | MN
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