Healthcare Provider Details

I. General information

NPI: 1700802014
Provider Name (Legal Business Name): MICHAEL ANTHONY BERK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 FOREST PARK AVE STE 1100
SAINT LOUIS MO
63108-2979
US

IV. Provider business mailing address

PO BOX 7412037
CHICAGO IL
60674-2037
US

V. Phone/Fax

Practice location:
  • Phone: 314-333-4100
  • Fax: 314-333-4115
Mailing address:
  • Phone: 314-333-4100
  • Fax: 314-333-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR5J82
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberR5J82
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: