Healthcare Provider Details

I. General information

NPI: 1003432550
Provider Name (Legal Business Name): KIMBERLY EDEN BERKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2020
Last Update Date: 07/11/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 E ARKONA RD STE 100
MILAN MI
48160-9770
US

IV. Provider business mailing address

7575 GRAND RIVER RD STE 210
BRIGHTON MI
48114-9379
US

V. Phone/Fax

Practice location:
  • Phone: 734-439-2429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351049848
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: