Basic Information
| Provider Information | |||||||||
| NPI: | 1326029265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERKOVIC | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27301 DEQUINDRE RD | ||||||||
| Address2: | STE 314 | ||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480713473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483994400 | ||||||||
| FaxNumber: | 2483994840 | ||||||||
| Practice Location | |||||||||
| Address1: | 27301 DEQUINDRE RD | ||||||||
| Address2: | STE 314 | ||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480713473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483994400 | ||||||||
| FaxNumber: | 2483994840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 03/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 5101006685 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 4385521-11 | 05 | MI | MEDICAID |