Provider Demographics
NPI:1043232523
Name:BERMAN, BRIAN W (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:BERMAN
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 1:680 HANNA ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1618
Mailing Address - Country:US
Mailing Address - Phone:216-789-3470
Mailing Address - Fax:313-966-6121
Practice Address - Street 1:CHILDREN HOSP MICHIGAN
Practice Address - Street 2:3901 BEAUBIEN ST
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:216-789-3470
Practice Address - Fax:313-966-6121
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011018292080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F349850OtherBCBSM COMMON PIN
MI1043232523Medicaid
MI0F34985253Medicare PIN