Provider Demographics
NPI:1699737122
Name:BERGERSEN, DEAN HENRY (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:HENRY
Last Name:BERGERSEN
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 1:410 E CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55307-2128
Mailing Address - Country:US
Mailing Address - Phone:507-964-5570
Mailing Address - Fax:
Practice Address - Street 1:601 W CHANDLER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MN
Practice Address - Zip Code:55307-2127
Practice Address - Country:US
Practice Address - Phone:507-964-2271
Practice Address - Fax:507-964-8490
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN583575500Medicaid
MND48398Medicare UPIN