Bergstrom, Lance K

Bergstrom, Lance K is an individual health care provider with primary practice located at 2601 University Dr S , Fargo ND 58103-6025. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Bergstrom, Lance K can be contacted via phone (701) 235-5200.

Contact Information

Primary practice address
2601 University Dr S Fargo ND 58103-6025
Phone: (701) 235-5200
Fax: (701) 237-0927
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 7230 North Dakota
Other Service Providers / Specialist 174400000X 38105 Minnesota

Profile Details

NPI number 1578509733
LBN Legal business name Bergstrom, Lance K
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2006
Last updated Aug 9th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578509733 NPPES
North Dakota MEDICAID 18672
North Dakota Other 33A71BE
North Dakota MEDICAID 080024400
North Dakota Other 01068001
North Dakota MEDICAID 12698
North Dakota Other 33A70BE
North Dakota Other 236454

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