Provider Demographics
NPI:1902008444
Name:BERRIS, KAREN KOENIG (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:KOENIG
Last Name:BERRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32255 NORTHWESTERN HWY STE 214
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1573
Mailing Address - Country:US
Mailing Address - Phone:248-855-5620
Mailing Address - Fax:248-855-5628
Practice Address - Street 1:32255 NORTHWESTERN HWY STE 214
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-855-5620
Practice Address - Fax:248-855-5628
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080081207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F36099Medicare PIN