Provider Demographics
NPI:1659362069
Name:BERG, DANIEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:BERG
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 1:500 FIDDLER AVE SE
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-6831
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?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41576207Q00000X, 207QA0000X, 207QG0300X, 207QS0010X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Not Answered207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH05794Medicare UPIN