Provider Demographics
NPI:1043230188
Name:BERLIN, PAULA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BERLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W GRAND RIVER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1647
Mailing Address - Country:US
Mailing Address - Phone:810-225-7773
Mailing Address - Fax:810-225-7774
Practice Address - Street 1:205 W GRAND RIVER AVE STE 200
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1647
Practice Address - Country:US
Practice Address - Phone:810-225-7773
Practice Address - Fax:810-225-7774
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP124100004Medicare PIN