Healthcare Provider Details

I. General information

NPI: 1699604744
Provider Name (Legal Business Name): HASSAN ALI BERRY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 FORT ST
TRENTON MI
48183-4601
US

IV. Provider business mailing address

5450 FORT ST
TRENTON MI
48183-4601
US

V. Phone/Fax

Practice location:
  • Phone: 734-671-3800
  • Fax:
Mailing address:
  • Phone: 734-671-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5151018100
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: