Provider Demographics
NPI:1588645741
Name:BERKSON, MICHAEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:BERKSON
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:866-630-9882
Mailing Address - Fax:920-682-5810
Practice Address - Street 1:3253 S HARLEM AVE STE 1A
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3073
Practice Address - Country:US
Practice Address - Phone:708-788-3885
Practice Address - Fax:708-788-6884
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088539207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088539Medicaid
ILF37723Medicare UPIN