Provider Demographics
NPI:1720043656
Name:BERMAN, MARTIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:B
Last Name:BERMAN
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 1:29927 6 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3670
Mailing Address - Country:US
Mailing Address - Phone:734-522-0800
Mailing Address - Fax:734-522-1236
Practice Address - Street 1:29927 6 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3670
Practice Address - Country:US
Practice Address - Phone:734-522-0800
Practice Address - Fax:734-522-1236
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMB026396207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0820689OtherMR ADVANTAGE PIN
MI180820689OtherBC PIN
MIOH24256OtherBC GROUP PIN
MI1114098Medicaid
MIMB026396OtherSTATE LICENSE
MIOH24256OtherBC GROUP PIN
MIB47141Medicare UPIN
MI0820689OtherMR ADVANTAGE PIN
MI1114098Medicaid
MIMB026396OtherSTATE LICENSE
MICH0161Medicare PIN