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General NPI Number Information
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NPI Number | 1922071125
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Entity Type | Organization
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Legal Business Name | JOHN H BERG MD CARL E BURKLAND MD
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 07/13/2015
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Provider Practice Location Address
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Address Line | 1400 1ST ST NE
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City | NEW PRAGUE
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State | MN
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Zip | 56071-2215
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Country | US
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Telephone | 952-758-2535
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Fax | 952-758-6101
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Provider Business Mailing Address
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Address Line | 1400 1ST ST NE PO BOX 186
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City | NEW PRAGUE
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State | MN
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Zip | 56071-2215
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Country | US
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Telephone | 952-758-2535
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Fax | 952-758-6101
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MARK A BERG
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Credential | MD
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Telephone | 952-548-6173
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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 | 38780
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License Number State | MN
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