Provider Demographics
NPI:1508808668
Name:BERK, WILLIAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:BERK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4201 SAINT ANTOINE ST
Mailing Address - Street 2:DETROIT RECEIVING HOSPITAL EMERGENCY DEPT.--3R
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-3331
Mailing Address - Fax:313-745-3653
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:DETROIT RECEVING HOSPITAL EMERGENCY DEPT.--3R
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-3331
Practice Address - Fax:313-745-3653
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-06-18
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Provider Licenses
StateLicense IDTaxonomies
MI4301044761207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIWB044761OtherBC/BS OF MICHIGAN
MI101987768Medicaid
MI103309614Medicaid
MI101987768Medicaid
MIH26348055Medicare PIN