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Individual
LANCE K BERGSTROM
Active
Individual
LANCE K BERGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
38105
MN
174400000X
Specialist
Primary
7230
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01068001
BCBS OF ND
ND
05
—
080024400
—
MN
05
—
12698
—
ND
05
—
18672
—
ND
01
—
236454
ND BCBS
ND
01
—
33A70BE
MN BCBS
MN
01
—
33A71BE
MN BCBS
MN
Enumeration date
06/22/2006
Last updated
08/09/2010
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