MEDICARE: PETER BERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	45666	MN

General Provider Information

NPI Number	:	1285737106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER BERG MD

Provider Business Mailing Address
First Line	:	5200 FAIRVIEW BLVD
Second Line	:
City	:	WYOMING
State	:	MN
Zip	:	55092-8013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	762 WEST 4TH STREET
Second Line	:
City	:	RUSH CITY
State	:	MN
Zip	:	55069
Country	:	US
Telephone Number	:	320-358-4784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	05/01/2008

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Directions to “ PETER BERG MD” Practice Location

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