Individual
DR. MARY SUE BERAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15111 TWELVE OAKS CENTER DR, MINNETONKA, MN 55305-5201
(952) 993-4500
Mailing address
3800 PARK NICOLLET BLVD, CREDENTIALING, ST LOUIS PARK, MN 55416-2527
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
40540
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
056018900
—
MN
Enumeration date
12/27/2005
Last updated
02/29/2012
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