Provider Demographics
NPI:1932545886
Name:BERLIN, JONAS P (DO)
Entity Type:Individual
Prefix:
First Name:JONAS
Middle Name:P
Last Name:BERLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4830 BECKER DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8616
Mailing Address - Country:US
Mailing Address - Phone:616-252-3900
Mailing Address - Fax:231-728-4789
Practice Address - Street 1:4830 BECKER DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8616
Practice Address - Country:US
Practice Address - Phone:616-252-3900
Practice Address - Fax:231-728-4789
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101020499207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N28430OtherGROUP PTAN