Healthcare Provider Details

I. General information

NPI: 1699921163
Provider Name (Legal Business Name): PAUL ALASON BERGER III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TOWNSHIP MI
48038-3504
US

IV. Provider business mailing address

18405 MANORWOOD S
CLINTON TOWNSHIP MI
48038-4813
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2959
  • Fax:
Mailing address:
  • Phone: 712-898-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number9499
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number9499
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: