Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301087318 | MI |
N | 207VX0201X | Gynecologic Oncologist | 036112040 | IL |
NPI | 1013996255 |
---|---|
Provider Name | Paul I Berkowitz |
First Address | Kalamazoo, MI 49007-5341 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2006 |
Last Update Date | 08/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036112040 | (05) | IL |
4852967 | (05) | MI |
5700239 | BCBS GROUP NUMBER (01) | IL |
K11241 | PIN (01) |