Healthcare Provider Details

I. General information

NPI: 1285635078
Provider Name (Legal Business Name): MICHAEL LAWRENCE BERMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 W UNION HILLS DR BLDG A, SUITE 140
GLENDALE AZ
85308-1096
US

IV. Provider business mailing address

6320 W UNION HILLS DR BLDG A, SUITE 140
GLENDALE AZ
85308-1096
US

V. Phone/Fax

Practice location:
  • Phone: 480-347-0844
  • Fax: 480-347-0885
Mailing address:
  • Phone: 480-347-0844
  • Fax: 480-347-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3432
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number3432
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: