MEDICARE: DANNY P BERK MD

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	207Q00000X	Family Medicine Physician	ME97046	FL

General Provider Information

NPI Number	:	1871588749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANNY P BERK MD

Provider Business Mailing Address
First Line	:	2200 W EAU GALLIE BLVD
Second Line	:	SUITE 101
City	:	MELBOURNE
State	:	FL
Zip	:	32935-3165
Country	:	US
Telephone Number	:	321-253-2900
Fax Number	:	321-435-0100

Provider Business Practice Location Address
First Line	:	8057 SPYGLASS HILL RD
Second Line	:	SUITE 104
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8565
Country	:	US
Telephone Number	:	321-241-4877
Fax Number	:	321-241-4879

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	05/07/2015

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