Healthcare Provider Details

I. General information

NPI: 1497796437
Provider Name (Legal Business Name): ALAN D BERSTED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W 6TH ST
CLARE MI
48617-1409
US

IV. Provider business mailing address

2000 GREEN RD SUITE 300
ANN ARBOR MI
48105-1598
US

V. Phone/Fax

Practice location:
  • Phone: 989-386-9951
  • Fax:
Mailing address:
  • Phone: 734-995-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number041102
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: