Provider Demographics
NPI:1922237908
Name:ANDREW H BERRY DO PC
Entity Type:Organization
Organization Name:ANDREW H BERRY DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-363-7123
Mailing Address - Street 1:522 W COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3923
Mailing Address - Country:US
Mailing Address - Phone:248-363-7123
Mailing Address - Fax:248-363-5890
Practice Address - Street 1:522 W COMMERCE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-3923
Practice Address - Country:US
Practice Address - Phone:248-363-7123
Practice Address - Fax:248-363-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101004123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0856301OtherHEALTH PLUS
MI1006878-11OtherMOLINA
MI1006878-11Medicaid
5707266OtherAETNA
MI104752OtherGREAT LAKES HEALTH PLAN
MI118-1OtherTOTAL HEALTH CARE
106153OtherPRIORITY HEALTH
MI169643-01OtherUNITED HEALTH CARE
MI5630142OtherBLUE CARE NETWORK
MI5630142OtherBLUE CROSS BLUE SHIELD MICHIGAN
E25466OtherHAP
1024847OtherMCLAREN HEALTH PLAN
MI1006878-11OtherMOLINA
MI104752OtherGREAT LAKES HEALTH PLAN
=========OtherCOFINITY