MEDICARE: JO M BERGER 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	207R00000X	Internal Medicine Physician	23954	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23954	OTHER	MN	MEDICAL LICENSE

General Provider Information

NPI Number	:	1487653473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO M BERGER MD

Provider Business Mailing Address
First Line	:	2200 COMMERCE BLVD
Second Line	:
City	:	MOUND
State	:	MN
Zip	:	55364-1547
Country	:	US
Telephone Number	:	952-495-2000
Fax Number	:	952-495-2060

Provider Business Practice Location Address
First Line	:	2200 COMMERCE BLVD
Second Line	:
City	:	MOUND
State	:	MN
Zip	:	55364-1547
Country	:	US
Telephone Number	:	952-495-2000
Fax Number	:	952-495-2060

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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