Provider Demographics
NPI:1427009729
Name:BERRY, ALI A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:A
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:43151 DALCOMA DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6306
Mailing Address - Country:US
Mailing Address - Phone:586-286-8720
Mailing Address - Fax:586-286-8723
Practice Address - Street 1:361 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5096
Practice Address - Country:US
Practice Address - Phone:734-495-1506
Practice Address - Fax:734-495-1780
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-03-04
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Provider Licenses
StateLicense IDTaxonomies
MI4301080146207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDO8072OtherRAILROAD MEDICARE