Provider Demographics
NPI:1518958214
Name:BERG, JOHN HOWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOWARD
Last Name:BERG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:307 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-1641
Mailing Address - Country:US
Mailing Address - Phone:952-758-2535
Mailing Address - Fax:952-548-6160
Practice Address - Street 1:1400 1ST ST NE
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2215
Practice Address - Country:US
Practice Address - Phone:952-758-2535
Practice Address - Fax:952-548-6160
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18675207Q00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN476368800Medicaid
MND75640Medicare UPIN
MN089003603Medicare ID - Type Unspecified