Provider Demographics
NPI:1841347085
Name:MICHAEL E. BERGER PA
Entity type:Organization
Organization Name:MICHAEL E. BERGER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:952-929-2276
Mailing Address - Street 1:5353 GAMBLE DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1509
Mailing Address - Country:US
Mailing Address - Phone:952-929-2276
Mailing Address - Fax:952-929-8576
Practice Address - Street 1:5353 GAMBLE DR
Practice Address - Street 2:SUITE 160
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1509
Practice Address - Country:US
Practice Address - Phone:952-929-2276
Practice Address - Fax:952-929-8576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1910103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN431547200Medicaid
MN431547200Medicaid