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General NPI Number Information
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NPI Number | 1003367426
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Entity Type | Individual
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Provider Name | ALAN DAVID BERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 4014 RIVER RD BUILDING 3B
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City | EAST CHINA
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State | MI
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Zip | 48054-2916
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Country | US
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Telephone | 810-329-4779
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Fax | 810-329-7860
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Provider Business Mailing Address
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Address Line | 4014 RIVER RD BUILDING 3B
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City | EAST CHINA
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State | MI
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Zip | 48054-2916
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Country | US
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Telephone | 810-329-4779
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Fax | 810-329-7860
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301111128
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License Number State | MI
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