Healthcare Provider Details

I. General information

NPI: 1215463708
Provider Name (Legal Business Name): CHANTEIL LENISE BERRIEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST 6C
DETROIT MI
48201-2153
US

IV. Provider business mailing address

19032 HARRISON AVE
LIVONIA MI
48152-3572
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-5009
  • Fax: 313-577-5310
Mailing address:
  • Phone: 313-377-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: