Healthcare Provider Details

I. General information

NPI: 1013996255
Provider Name (Legal Business Name): PAUL I BERKOWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN STREET BOX 42
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

601 JOHN STREET SUITE N1200
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-6417
  • Fax: 269-341-8743
Mailing address:
  • Phone: 269-341-7979
  • Fax: 269-341-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301087318
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number036112040
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: