Provider Demographics
NPI:1124019997
Name:BERES, MICHAEL BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRIAN
Last Name:BERES
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:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-0116
Mailing Address - Country:US
Mailing Address - Phone:304-792-1480
Mailing Address - Fax:304-792-1481
Practice Address - Street 1:77 HOSPITAL DR
Practice Address - Street 2:SUITE 400
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3451
Practice Address - Country:US
Practice Address - Phone:304-792-1480
Practice Address - Fax:304-792-1481
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20176207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1802361001Medicaid
WV180045749OtherRR MEDICARE
WV001705979OtherBLUE CROSS BLUE SHIELD
562873OtherSTERLING LIFE
226977OtherCOVENTRY ADVANDTRA FREEDOM
WV180045749OtherRR MEDICARE
562873OtherSTERLING LIFE