Healthcare Provider Details

I. General information

NPI: 1043232523
Provider Name (Legal Business Name): BRIAN W BERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/04/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN HOSP MICHIGAN 3901 BEAUBIEN ST
DETROIT MI
48201
US

IV. Provider business mailing address

680 HANNA ST
BIRMINGHAM MI
48009-1618
US

V. Phone/Fax

Practice location:
  • Phone: 216-789-3470
  • Fax: 313-966-6121
Mailing address:
  • Phone: 216-789-3470
  • Fax: 313-966-6121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number4301101829
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: