Healthcare Provider Details

I. General information

NPI: 1528760345
Provider Name (Legal Business Name): MICHAEL ROBERT BEREISHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39200 HOOKER HWY
BELLE GLADE FL
33430-5368
US

IV. Provider business mailing address

3827 N 267TH CIR
VALLEY NE
68064-4434
US

V. Phone/Fax

Practice location:
  • Phone: 561-642-1000
  • Fax:
Mailing address:
  • Phone: 402-714-6587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-53387
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-53387
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: