Healthcare Provider Details

I. General information

NPI: 1487694949
Provider Name (Legal Business Name): SUSAN BERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 ST ANTOINE STE 4E&F UNIVERSITY HEALTH CENTER
DETROIT MI
48201
US

IV. Provider business mailing address

1560 E MAPLE RD SUITE 400-CREDENTIALING
TROY MI
48083-1138
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4380
  • Fax: 313-993-0692
Mailing address:
  • Phone: 313-745-4380
  • Fax: 313-993-0692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number4301066892
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: