Provider Demographics
NPI:1730143074
Name:BERL, SHARI D (DO)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:D
Last Name:BERL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:40133 N LYTHAM WAY
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2926
Mailing Address - Country:US
Mailing Address - Phone:913-894-6500
Mailing Address - Fax:913-894-6001
Practice Address - Street 1:12428 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-3113
Practice Address - Country:US
Practice Address - Phone:623-344-6500
Practice Address - Fax:623-344-6501
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-20392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCD6440OtherMEDICARE RAILROAD GRP #
KS120002133OtherMEDICARE RAILROAD PIN
KSCD6440OtherMEDICARE RAILROAD GRP #
KS120002133OtherMEDICARE RAILROAD PIN