Provider Demographics
NPI:1730138173
Name:BERENHOLZ, JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:BERENHOLZ
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 1:30445 NORTHWESTERN HWY OFC 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3168
Mailing Address - Country:US
Mailing Address - Phone:248-865-0426
Mailing Address - Fax:248-865-0430
Practice Address - Street 1:30445 NORTHWESTERN HWY OFC 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3168
Practice Address - Country:US
Practice Address - Phone:248-865-0426
Practice Address - Fax:248-865-0430
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB045238207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0630441OtherBLUE CARE NETWORK
MI232891OtherOMNI CARE
MI383472675OtherAETNA
MIB45518OtherHEALTH ALLIANCE PLAN
MI4144359Medicaid
MI1010318-0004OtherWELLNESS PLAN
MI6171151004OtherCIGNA
MI0630441OtherBCBS OF MICHIGAN
MIB7870OtherM-CARE
MI127194OtherCARE CHOICES
MIB43436Medicare UPIN
MI1010318-0004OtherWELLNESS PLAN