Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 2901020803 | MI |
Y | 213EG0000X | General Practice | 2901020803 | MI |
NPI | 1003166729 |
---|---|
Provider Name | Dr. Michael Evan Berman |
First Address | Plymouth, MI 48170-4186 |
Second Address | Plymouth, MI 48170-4186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2012 |
Last Update Date | 21/03/2017 |