Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 4301076956 | MI |
NPI | 1669496600 |
---|---|
Provider Name | Dr. Michael E. Berry |
First Address | Saint Joseph, MI 49085-9151 |
Second Address | Saint Joseph, MI 49085-9151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 29/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I61282 | (02) | MI |