Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4095 | IA |
N | 111NI0900X | Internist | 4095 | IA |
N | 207R00000X | Internist | 54798 | MN |
N | 111NI0900X | Internist | 54798 | MN |
N | 207R00000X | Internist | 675 | NE |
N | 111NI0900X | Internist | 675 | NE |
Y | 207RC0200X | Critical Care Medicine | 54798 | MN |
NPI | 1003014911 |
---|---|
Provider Name | Dr. John Paul Berger |
First Address | Minneapolis, MN 55417-1674 |
Second Address | Maplewood, MN 55109-5465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 10/05/2021 |