Provider Demographics
NPI:1679623326
Name:BERKOFF, JONATHAN H (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:H
Last Name:BERKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 N LAKE DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4528
Mailing Address - Country:US
Mailing Address - Phone:414-289-9669
Mailing Address - Fax:414-289-9693
Practice Address - Street 1:2350 N LAKE DR
Practice Address - Street 2:SUITE 500
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4528
Practice Address - Country:US
Practice Address - Phone:414-289-9669
Practice Address - Fax:414-289-9693
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37497207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32204100Medicaid
G16501Medicare UPIN
WI01083Medicare ID - Type Unspecified