Provider Demographics
NPI:1558476804
Name:BEREZA, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:BEREZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1300 MICHIGAN ST NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2026
Mailing Address - Country:US
Mailing Address - Phone:616-774-9515
Mailing Address - Fax:616-774-7116
Practice Address - Street 1:1300 MICHIGAN ST NE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2026
Practice Address - Country:US
Practice Address - Phone:616-774-9515
Practice Address - Fax:616-774-7116
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRB038229207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1341087Medicaid
MI0N96810001Medicare PIN
MIA73399Medicare UPIN