Provider Demographics
NPI:1275564197
Name:BERKOWITZ, PAUL M (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:BERKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1512 ARTAIUS PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5231
Mailing Address - Country:US
Mailing Address - Phone:847-847-2230
Mailing Address - Fax:833-464-0923
Practice Address - Street 1:1512 ARTAIUS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5231
Practice Address - Country:US
Practice Address - Phone:847-847-2230
Practice Address - Fax:833-464-0923
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ358372084P0800X
IL0360985962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ120454Medicare PIN