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General NPI Number Information
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NPI Number | 1134320930
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Entity Type | Individual
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Provider Name | NEESHA ROCHELLE BERRY M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 26400 W 12 MILE RD STE 110
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1771
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Country | US
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Telephone | 248-833-6300
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Fax | 248-833-6200
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Provider Business Mailing Address
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Address Line | 30123 ROCK CREEK DR
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5358
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Country | US
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Telephone | 313-516-1641
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301081792
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License Number State | MI
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