Provider Demographics
NPI:1477522902
Name:BERKWITS, KIEVE M (MD)
Entity Type:Individual
Prefix:
First Name:KIEVE
Middle Name:M
Last Name:BERKWITS
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:PO BOX 5246
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-0246
Mailing Address - Country:US
Mailing Address - Phone:203-384-3873
Mailing Address - Fax:203-384-3829
Practice Address - Street 1:226 MILL HILL AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2811
Practice Address - Country:US
Practice Address - Phone:203-384-3873
Practice Address - Fax:203-384-3829
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026361208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001263615Medicaid
CT001263615Medicaid
CTE27082Medicare UPIN