Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101019691 | MI |
NPI | 1396004552 |
---|---|
Provider Name | Dr. Amber Jean Berry |
First Address | Kalamazoo, MI 49009-2123 |
Second Address | Kalamazoo, MI 49009-2123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2012 |
Last Update Date | 24/01/2018 |