MEDICARE: MS. CHIQUITA LASHANE BERG 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	207V00000X	Obstetrics & Gynecology Physician	ME134169	FL
2	207V00000X	Obstetrics & Gynecology Physician	01079219A	IN
3	207V00000X	Obstetrics & Gynecology Physician	4301077885	MI

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

General Provider Information

NPI Number	:	1184612814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHIQUITA LASHANE BERG MD

Provider Business Mailing Address
First Line	:	24 FRANK LLOYD WRIGHT DR STE J2000
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9484
Country	:	US
Telephone Number	:	734-747-6766
Fax Number	:	734-222-3100

Provider Business Practice Location Address
First Line	:	32932 WARREN RD STE 100
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-3095
Country	:	US
Telephone Number	:	734-743-4500
Fax Number	:	734-743-4362

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	03/19/2025

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