Healthcare Provider Details

I. General information

NPI: 1740287341
Provider Name (Legal Business Name): KEVIN M BERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6036 N 19TH AVE STE 510
PHOENIX AZ
85015-2143
US

IV. Provider business mailing address

3815 E BELL RD STE 2200
PHOENIX AZ
85032-2139
US

V. Phone/Fax

Practice location:
  • Phone: 602-973-1113
  • Fax: 602-973-1116
Mailing address:
  • Phone: 602-633-3838
  • Fax: 602-633-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number28977
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: