Healthcare Provider Details

I. General information

NPI: 1316067895
Provider Name (Legal Business Name): HADI BERRY D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18550 OUTER DR
DEARBORN MI
48128-1872
US

IV. Provider business mailing address

18550 OUTER DR
DEARBORN MI
48128-1872
US

V. Phone/Fax

Practice location:
  • Phone: 313-724-6008
  • Fax: 888-820-3056
Mailing address:
  • Phone: 313-724-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101016963
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: