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NPI Code Detail

MEDICARE: DONALD D BERRY PA

MEDICARE: DONALD D BERRY PA
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
1363A00000XPhysician Assistant5601007737MI

General Provider Information

NPI Number : 1164870275
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD D BERRY PA
Provider Business Mailing Address
First Line : 130 TOWN CENTER DR STE 203
Second Line : BEAUMONT MEDICAL STAFF AFFAIRS
City : TROY
State : MI
Zip : 48084-1744
Country : US
Telephone Number : 248-585-8218
Fax Number : 248-585-8266
Provider Business Practice Location Address
First Line : 44201 DEQUINDRE RD
Second Line : BEAUMONT HOSPITAL - TROY
City : TROY
State : MI
Zip : 48085-1117
Country : US
Telephone Number : 248-964-5000
Fax Number : 248-964-4848
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2016
Last Update Date : 05/29/2026

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