Provider Demographics
NPI:1770536450
Name:FREIBERG, MARK ROGER (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROGER
Last Name:FREIBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:255 SMITH AVE N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2572
Mailing Address - Country:US
Mailing Address - Phone:651-726-6200
Mailing Address - Fax:651-726-6201
Practice Address - Street 1:255 SMITH AVE N
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2572
Practice Address - Country:US
Practice Address - Phone:651-726-6200
Practice Address - Fax:651-726-6201
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-11-10
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Provider Licenses
StateLicense IDTaxonomies
MN32862207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN192598900Medicaid
MNE19391Medicare UPIN
MN290000808Medicare PIN