Provider Demographics
NPI:1104861350
Name:BERGER, ALAN KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KEITH
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 NORWOOD LN N # 4250
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2743
Mailing Address - Country:US
Mailing Address - Phone:612-281-3890
Mailing Address - Fax:
Practice Address - Street 1:4250 NORWOOD LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-2743
Practice Address - Country:US
Practice Address - Phone:612-281-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42601207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN127912OtherUCARE
MN25-00021OtherMEDICA PRIMARY
WI34016800Medicaid
SD7777470Medicaid
MN497450600Medicaid
ND10387Medicaid
MN1052867OtherARAZ
MN78R84BEOtherBCBS
MN1024708OtherPREFERRED ONE
MN25-00346OtherMEDICA CHOICE
KS30004807510001Medicaid
MNHP31264OtherHEALTHPARTNERS
IA0532846Medicaid
MN06005832Medicare ID - Type UnspecifiedMN MEDICARE
WI34016800Medicaid