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:
Health care specialties
| Specialty | Code | License # | 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 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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