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General NPI Number Information
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NPI Number | 1326386517
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Entity Type | Organization
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Legal Business Name | BERRY DERMATOLOGY, P.C.
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 01/24/2013
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Provider Practice Location Address
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Address Line | 50505 SCHOENHERR RD SUITE 325
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-3140
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Country | US
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Telephone | 586-286-8720
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Fax | 586-286-8723
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Provider Business Mailing Address
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Address Line | 43151 DALCOMA DR
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6306
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Country | US
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Telephone | 586-286-8720
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Fax | 586-286-8723
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALI A. BERRY
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Credential | M.D.
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Telephone | 734-495-1506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4301080146
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License Number State | MI
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