Provider Demographics
NPI:1275634982
Name:BERKOWITZ, BRUCE MILES (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:MILES
Last Name:BERKOWITZ
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 1:5258 LINTON BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6540
Mailing Address - Country:US
Mailing Address - Phone:561-498-3002
Mailing Address - Fax:561-496-1719
Practice Address - Street 1:5258 LINTON BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6540
Practice Address - Country:US
Practice Address - Phone:561-498-3002
Practice Address - Fax:561-496-1719
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046371207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00007014OtherRAILROAD MEDICARE
FL044696300Medicaid
FL061666540OtherTAX ID NUMBER
FLP00007014OtherRAILROAD MEDICARE
FL061666540OtherTAX ID NUMBER
FL1275634982Medicare NSC
FL1013002112Medicare NSC