Healthcare Provider Details

I. General information

NPI: 1366485609
Provider Name (Legal Business Name): EDWARD D BERG DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 W SAGINAW HWY SUITE 300
LANSING MI
48917-1131
US

IV. Provider business mailing address

7201 W SAGINAW HWY SUITE 300
LANSING MI
48917-1131
US

V. Phone/Fax

Practice location:
  • Phone: 517-321-6801
  • Fax:
Mailing address:
  • Phone: 517-321-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD D BERG
Title or Position: DO
Credential:
Phone: 517-321-6801