Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301111128 | MI |
Y | 208600000X | Surgeon | 4301111128 | MI |
NPI | 1003367426 |
---|---|
Provider Name | Dr. Alan David Berg |
First Address | East China, MI 48054-2916 |
Second Address | East China, MI 48054-2916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2016 |
Last Update Date | 20/10/2016 |