Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | R74933 | AZ |
N | 208600000X | Surgeon | R74933 | AZ |
Y | 208800000X | Urologist | 66792 | MN |
NPI | 1063899250 |
---|---|
Provider Name | Andrew Bergersen |
First Address | Minneapolis, MN 55426-2841 |
Second Address | Robbinsdale, MN 55422-2977 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2015 |
Last Update Date | 01/07/2020 |