Provider Demographics
NPI:1487653473
Name:BERGER, JO M (MD)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:M
Last Name:BERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 COMMERCE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-1547
Mailing Address - Country:US
Mailing Address - Phone:952-495-2000
Mailing Address - Fax:952-495-2060
Practice Address - Street 1:2200 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:MOUND
Practice Address - State:MN
Practice Address - Zip Code:55364-1547
Practice Address - Country:US
Practice Address - Phone:952-495-2000
Practice Address - Fax:952-495-2060
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN23954207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN23954OtherMEDICAL LICENSE
MN23954OtherMEDICAL LICENSE