Provider Demographics
NPI:1669496600
Name:BERRY, MICHAEL E (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3950 HOLLYWOOD RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9151
Mailing Address - Country:US
Mailing Address - Phone:269-429-4263
Mailing Address - Fax:269-429-4267
Practice Address - Street 1:3950 HOLLYWOOD RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9151
Practice Address - Country:US
Practice Address - Phone:269-429-4263
Practice Address - Fax:269-429-4267
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010769562086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP35250001Medicare PIN
MII61282Medicare UPIN