Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 59658 | MN |
N | 207YP0228X | Pediatric Otolaryngology | 59658 | MN |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 59658 | MN |
NPI | 1972747871 |
---|---|
Provider Name | Dr. Micah Avner Berman |
First Address | Saint Paul, MN 55101-2507 |
Second Address | Saint Paul, MN 55101-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2009 |
Last Update Date | 22/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H400252166 | MEDICARE PTAN (01) | MN |