Provider Demographics
NPI:1669637856
Name:BERRY, TIFFANY S (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:S
Last Name:BERRY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:315 E BROADWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3700
Practice Address - Country:US
Practice Address - Phone:502-629-4500
Practice Address - Fax:502-629-4501
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2021-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY43772208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery