Provider Demographics
NPI:1437178811
Name:BERGMAN, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BERGMAN
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 1:825 NICOLLET MALL STE 1227
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2702
Mailing Address - Country:US
Mailing Address - Phone:612-339-4843
Mailing Address - Fax:612-339-9168
Practice Address - Street 1:825 NICOLLET MALL STE 1227
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2702
Practice Address - Country:US
Practice Address - Phone:612-339-4843
Practice Address - Fax:612-339-9168
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18723207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0327994OtherMEDICA
MN217763300Medicaid
070016473OtherRAILROAD MEDICARE
MN3925OtherHEALTH PARTNERS
01282BEOtherBLUE CROSS, BLUE SHIELD
MN071610302Medicare PIN
MNA96017Medicare UPIN