Healthcare Provider Details

I. General information

NPI: 1871816694
Provider Name (Legal Business Name): MICHAEL DAVID BERVEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22100 BOTHELL EVERETT HWY
BOTHELL WA
98021-8431
US

IV. Provider business mailing address

22100 BOTHELL EVERETT HWY
BOTHELL WA
98021-8431
US

V. Phone/Fax

Practice location:
  • Phone: 855-687-7237
  • Fax:
Mailing address:
  • Phone: 855-687-7237
  • Fax: 855-673-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number283158
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberSP.125
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number75930
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number26448
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: