MEDICARE: JOHN BERGMAN M.D.

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	207N00000X	Dermatology Physician	18723	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	070016473	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0327994	OTHER	MN	MEDICA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3925	OTHER	MN	HEALTH PARTNERS
5	01282BE	OTHER		BLUE CROSS, BLUE SHIELD

General Provider Information

NPI Number	:	1437178811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BERGMAN M.D.

Provider Business Mailing Address
First Line	:	825 NICOLLET MALL STE 1227
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2702
Country	:	US
Telephone Number	:	612-339-4843
Fax Number	:	612-339-9168

Provider Business Practice Location Address
First Line	:	825 NICOLLET MALL STE 1227
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2702
Country	:	US
Telephone Number	:	612-339-4843
Fax Number	:	612-339-9168

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	06/16/2008

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Directions to “ JOHN BERGMAN M.D.” Practice Location

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