Provider Demographics
NPI:1013996255
Name:BERKOWITZ, PAUL I (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:I
Last Name:BERKOWITZ
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 1:601 JOHN STREET
Mailing Address - Street 2:SUITE N1200
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7979
Mailing Address - Fax:269-341-6261
Practice Address - Street 1:601 JOHN STREET
Practice Address - Street 2:BOX 42
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-6417
Practice Address - Fax:269-341-8743
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112040207VX0201X
MI4301087318207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4852967Medicaid
IL5700239OtherBCBS GROUP NUMBER
IL036112040Medicaid
K11241OtherPIN
IL5700239OtherBCBS GROUP NUMBER
MIC97618123Medicare PIN