1104861350 NPI number — DR. ALAN KEITH BERGER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104861350 NPI number — DR. ALAN KEITH BERGER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BERGER

Provider First Name:

ALAN

Provider Middle Name:

KEITH

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1104861350

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/07/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

4250 NORWOOD LN N # 4250

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PLYMOUTH

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55442-2743

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-281-3890

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1016 TACOMA AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SUNNYSIDE

Provider Business Practice Location Address State Name:

WA

Provider Business Practice Location Address Postal Code:

98944-2263

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

509-837-1500

Provider Business Practice Location Address Fax Number:

509-837-4908

Provider Enumeration Date:

06/19/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  42601 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0000X , with the licence number: 42601 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RI0011X , with the licence number: 42601 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RI0011X , with the licence number: MD61283705 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1052867 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 497450600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 78R84BE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 25-00021 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 127912 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 25-00346 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 30004807510001 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 0532846 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 7777470 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 10387 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
• Identifier: HP31264 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1024708 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2258647 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: 34016800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".