Healthcare Provider Details

I. General information

NPI: 1821093410
Provider Name (Legal Business Name): KENNETH E BERKOVITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ARCH STREET
AKRON OH
44304-1437
US

IV. Provider business mailing address

PO BOX 2090, 525 E. MARKET STREET SUMMA PHYSICIANS INC.
AKRON OH
44309-2090
US

V. Phone/Fax

Practice location:
  • Phone: 330-376-7000
  • Fax: 330-376-1066
Mailing address:
  • Phone: 330-996-8603
  • Fax: 330-996-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35061657B
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35061657
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: