Provider Demographics
NPI:1013915099
Name:BERRY, MICHAEL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:BERRY
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 1:1625 N ALSTON ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2208
Mailing Address - Country:US
Mailing Address - Phone:251-970-1954
Mailing Address - Fax:251-970-1960
Practice Address - Street 1:1625 N ALSTON ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2208
Practice Address - Country:US
Practice Address - Phone:251-970-1954
Practice Address - Fax:251-970-1960
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12151207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5581199OtherAETNA
AL0515-13766OtherBCBS
AL2910028OtherUNITED HEALTHCARE
AL000034907Medicaid
AL100015318OtherRAILROAD MEDCARE
AL0510-34907OtherBCBS