MEDICARE: DR. MICHAEL LAWRENCE BERMAN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	3432	AZ
2	207R00000X	Internal Medicine Physician	3432	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285635078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL LAWRENCE BERMAN DO

Provider Business Mailing Address
First Line	:	6320 W UNION HILLS DR
Second Line	:	BLDG A, SUITE 140
City	:	GLENDALE
State	:	AZ
Zip	:	85308-1096
Country	:	US
Telephone Number	:	480-347-0844
Fax Number	:	480-347-0885

Provider Business Practice Location Address
First Line	:	6320 W UNION HILLS DR
Second Line	:	BLDG A, SUITE 140
City	:	GLENDALE
State	:	AZ
Zip	:	85308-1096
Country	:	US
Telephone Number	:	480-347-0844
Fax Number	:	480-347-0885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	02/24/2021

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