1689761140 NPI number — KIMBERLY ANNE BERGER AUDIOLOGIST

Table of content: KIMBERLY ANNE BERGER AUDIOLOGIST (NPI 1689761140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689761140 NPI number — KIMBERLY ANNE BERGER AUDIOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGER
Provider First Name:
KIMBERLY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUDIOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YARGER
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUDIOLOGIST
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1689761140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67000
Provider Second Line Business Mailing Address:
DEPARTMENT 272801
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48267-2728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-841-6913
Provider Business Mailing Address Fax Number:
517-841-6917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 TENEYCK ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49201-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-787-1468
Provider Business Practice Location Address Fax Number:
517-787-0613
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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