1922237908 NPI number — ANDREW H BERRY DO PC

Table of content: (NPI 1922237908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922237908 NPI number — ANDREW H BERRY DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDREW H BERRY DO PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922237908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
522 W COMMERCE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMERCE TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48382-3923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-363-7123
Provider Business Mailing Address Fax Number:
248-363-5890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
522 W COMMERCE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMERCE TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48382-3923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-363-7123
Provider Business Practice Location Address Fax Number:
248-363-5890
Provider Enumeration Date:
07/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BERRY
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
HENRY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-363-7123

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  5101004123 , 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)

  • Identifier: 0856301 . This is a "HEALTH PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1006878-11 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1006878-11 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5707266 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104752 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 118-1 . This is a "TOTAL HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 106153 . This is a "PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 169643-01 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5630142 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5630142 . This is a "BLUE CROSS BLUE SHIELD MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: E25466 . This is a "HAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1024847 . This is a "MCLAREN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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