Healthcare Provider Details

I. General information

NPI: 1144163056
Provider Name (Legal Business Name): MONIQUE FAY BERRY BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 CALIFORNIA ST
HIGHLAND PARK MI
48203-3517
US

IV. Provider business mailing address

24260 PRINCETON STREET
INKSTER MI
48141
US

V. Phone/Fax

Practice location:
  • Phone: 630-487-0813
  • Fax:
Mailing address:
  • Phone: 630-487-0813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: