Provider Demographics
NPI:1366485609
Name:EDWARD D BERG DO PC
Entity Type:Organization
Organization Name:EDWARD D BERG DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-321-6801
Mailing Address - Street 1:7201 W SAGINAW HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1131
Mailing Address - Country:US
Mailing Address - Phone:517-321-6801
Mailing Address - Fax:
Practice Address - Street 1:7201 W SAGINAW HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1131
Practice Address - Country:US
Practice Address - Phone:517-321-6801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P07880Medicare PIN