Provider Demographics
NPI:1740287341
Name:BERMAN, KEVIN M (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3815 E BELL RD STE 2200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2139
Mailing Address - Country:US
Mailing Address - Phone:602-633-3838
Mailing Address - Fax:602-633-3845
Practice Address - Street 1:6036 N 19TH AVE STE 510
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2143
Practice Address - Country:US
Practice Address - Phone:602-973-1113
Practice Address - Fax:602-973-1116
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28977207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ25-00625OtherUNITED HEALTHCARE
AZ1Z5674OtherHEALTHNET
AZAZ0881510OtherBLUE CROSS BLUE SHIELD
AZ060063387OtherRAILROAD MEDICARE
AZ550211Medicaid
AZE94318Medicare UPIN
AZ25-00625OtherUNITED HEALTHCARE