Provider Demographics
NPI:1801803309
Name:BERLIN, DAVID H (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:BERLIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 E LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3780
Mailing Address - Country:US
Mailing Address - Phone:248-528-0709
Mailing Address - Fax:248-528-1807
Practice Address - Street 1:2914 E LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3780
Practice Address - Country:US
Practice Address - Phone:248-528-0709
Practice Address - Fax:248-528-1807
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001005213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI485631470OtherBLUECROSSBLUESHIELD
MI89594BOtherHAP
MINC025717OtherPPOM PROVIDER CODE
MI1962526624OtherGROUP NPI
MI0005335144OtherAETNA
1801803309OtherINDIVIDUAL NPI
MI2114815Medicaid
MI480002521OtherCHAMPUS
MI2114815Medicaid
MI0005335144OtherAETNA
MI485631470OtherBLUECROSSBLUESHIELD