Provider Demographics
NPI:1225142524
Name:BERRY, MICHAEL ALDEN (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALDEN
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 WILCREST GREEN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4813
Mailing Address - Country:US
Mailing Address - Phone:713-978-7755
Mailing Address - Fax:713-978-5001
Practice Address - Street 1:11111 WILCREST GREEN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4813
Practice Address - Country:US
Practice Address - Phone:713-978-7755
Practice Address - Fax:713-978-5001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD81472083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine