Healthcare Provider Details

I. General information

NPI: 1225083967
Provider Name (Legal Business Name): ASHRAF H BERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27070 HOOVER RD
WARREN MI
48093-4590
US

IV. Provider business mailing address

627 S GULLEY RD
DEARBORN MI
48124-1235
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-9090
  • Fax: 586-573-2128
Mailing address:
  • Phone: 313-278-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number4301072120
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: