MEDICARE: MICHAEL BRIAN BERES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	20176	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180045749	OTHER	WV	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	001705979	OTHER	WV	BLUE CROSS BLUE SHIELD
4	562873	OTHER		STERLING LIFE
5	226977	OTHER		COVENTRY ADVANDTRA FREEDOM

General Provider Information

NPI Number	:	1124019997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BRIAN BERES MD

Provider Business Mailing Address
First Line	:	PO BOX 116
Second Line	:
City	:	LOGAN
State	:	WV
Zip	:	25601-0116
Country	:	US
Telephone Number	:	304-792-1480
Fax Number	:	304-792-1481

Provider Business Practice Location Address
First Line	:	77 HOSPITAL DR
Second Line	:	SUITE 400
City	:	LOGAN
State	:	WV
Zip	:	25601-3451
Country	:	US
Telephone Number	:	304-792-1480
Fax Number	:	304-792-1481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	08/21/2012

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Directions to “ MICHAEL BRIAN BERES MD” Practice Location

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