Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 4301101829 | MI |
NPI | 1043232523 |
---|---|
Provider Name | Brian W Berman |
First Address | Birmingham, MI 48009-1618 |
Second Address | Detroit, MI 48201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 04/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043232523 | (05) | MI |
700F349850 | BCBSM COMMON PIN (01) | MI |