Provider Demographics
NPI:1275526600
Name:BEROW, OWEN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:MARK
Last Name:BEROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:535 S BURDICK ST
Mailing Address - Street 2:#248
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5294
Mailing Address - Country:US
Mailing Address - Phone:269-385-4448
Mailing Address - Fax:269-385-3596
Practice Address - Street 1:535 S BURDICK ST
Practice Address - Street 2:#248
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5294
Practice Address - Country:US
Practice Address - Phone:269-385-4448
Practice Address - Fax:269-385-3596
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301031098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1090844Medicaid
MI1090844Medicaid
MI0395884Medicare ID - Type Unspecified