Provider Demographics
NPI:1326029265
Name:BERKOVIC, MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BERKOVIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27301 DEQUINDRE RD
Mailing Address - Street 2:STE 314
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3473
Mailing Address - Country:US
Mailing Address - Phone:248-399-4400
Mailing Address - Fax:248-399-4840
Practice Address - Street 1:27301 DEQUINDRE RD
Practice Address - Street 2:STE 314
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3473
Practice Address - Country:US
Practice Address - Phone:248-399-4400
Practice Address - Fax:248-399-4840
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006685207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4385521-11Medicaid
5631554Medicare ID - Type Unspecified
MI4385521-11Medicaid