Provider Demographics
NPI:1922071125
Name:JOHN H BERG MD CARL E BURKLAND MD
Entity Type:Organization
Organization Name:JOHN H BERG MD CARL E BURKLAND MD
Other - Org Name:PARKVIEW MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-548-6173
Mailing Address - Street 1:1400 1ST ST NE
Mailing Address - Street 2:PO BOX 186
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-2215
Mailing Address - Country:US
Mailing Address - Phone:952-758-2535
Mailing Address - Fax:952-758-6101
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:952-758-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN395010700Medicaid
MN51329PAOtherBLUE CROSS GROUP NUMBER
MN395010700Medicaid