Provider Demographics
NPI:1053314328
Name:BERMAN, MICHAEL I (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:I
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18700 N 64TH DR
Mailing Address - Street 2:STE 301
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7114
Mailing Address - Country:US
Mailing Address - Phone:623-561-5437
Mailing Address - Fax:623-561-9320
Practice Address - Street 1:18700 N 64TH DR
Practice Address - Street 2:STE 301
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7114
Practice Address - Country:US
Practice Address - Phone:623-561-5437
Practice Address - Fax:623-561-9320
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2011-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ2440208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ057613Medicaid