Provider Demographics
NPI:1659321289
Name:BJORGEN, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BJORGEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4801 W 81ST ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1111
Mailing Address - Country:US
Mailing Address - Phone:952-837-9700
Mailing Address - Fax:952-837-9701
Practice Address - Street 1:4801 W 81ST ST
Practice Address - Street 2:SUITE 108
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1111
Practice Address - Country:US
Practice Address - Phone:952-837-9700
Practice Address - Fax:952-837-9701
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2014-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN181312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN662595900Medicaid
MN662595900Medicaid
MNB58601Medicare UPIN