Provider Demographics
NPI:1710970983
Name:BERUTI, DAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:BERUTI
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 1:2020 N CENTRAL AVE
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4501
Mailing Address - Country:US
Mailing Address - Phone:602-553-8400
Mailing Address - Fax:602-553-8408
Practice Address - Street 1:2020 N CENTRAL AVE
Practice Address - Street 2:SUITE 1010
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4501
Practice Address - Country:US
Practice Address - Phone:602-553-8400
Practice Address - Fax:602-553-8408
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ856669-01Medicaid
AZZ79224Medicare PIN
AZ856669-01Medicaid
AZP00234870Medicare PIN