Healthcare Provider Details

I. General information

NPI: 1295815371
Provider Name (Legal Business Name): MICHAEL L BERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCI MEDICAL CENTER 101 THE CITY DRIVE SOUTH
ORANGE CA
92868
US

IV. Provider business mailing address

OB/GYN UNIVERSITY ASSOCIATES PO BOX 513980
LOS ANGELES CA
90051-3980
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-2986
  • Fax:
Mailing address:
  • Phone: 714-456-6431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number000000G21754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: