Provider Demographics
NPI:1689759839
Name:BERLIN, ALAN R (DO)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:BERLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3636
Mailing Address - Country:US
Mailing Address - Phone:810-732-3330
Mailing Address - Fax:810-732-2590
Practice Address - Street 1:1079 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-732-3330
Practice Address - Fax:810-732-2590
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006346207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0736595OtherHEALTH PLUS
MI0752511084OtherBCBS
MI1088200Medicaid
MI1088200Medicaid
MI0752511084OtherBCBS