Provider Demographics
NPI:1255511820
Name:ALAN R. BERLIN, D.O.P.C.
Entity type:Organization
Organization Name:ALAN R. BERLIN, D.O.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:ROBBIN
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-732-3330
Mailing Address - Street 1:1079 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3636
Mailing Address - Country:US
Mailing Address - Phone:810-732-3330
Mailing Address - Fax:810-732-2590
Practice Address - Street 1:1079 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3636
Practice Address - Country:US
Practice Address - Phone:810-732-3330
Practice Address - Fax:810-732-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006346207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0736595OtherHEALTH PLUS OF MICHIGAN
MI0752511084OtherBLUE CARE NETWORK
MI1088200Medicaid
MI0752511084OtherBLUE CROSS BLUE SHIELD
MI0736595OtherHEALTH PLUS OF MICHIGAN
MI0752511084OtherBLUE CARE NETWORK