Provider Demographics
NPI:1104803568
Name:BERGER, LARRY F (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:F
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7525 MITCHELL ROAD
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-1957
Mailing Address - Country:US
Mailing Address - Phone:952-657-5452
Mailing Address - Fax:952-657-5453
Practice Address - Street 1:7525 MITCHELL ROAD
Practice Address - Street 2:SUITE 200B
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-1957
Practice Address - Country:US
Practice Address - Phone:952-657-5452
Practice Address - Fax:952-657-5453
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2010-08-05
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Provider Licenses
StateLicense IDTaxonomies
MN295212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN342392100Medicaid
MN260000280Medicare ID - Type Unspecified
MN342392100Medicaid