MEDICARE: DR. ALI A BERRY 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	207N00000X	Dermatology Physician	4301080146	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DO8072	OTHER	MI	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1427009729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI A BERRY MD

Provider Business Mailing Address
First Line	:	43151 DALCOMA DR
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-6306
Country	:	US
Telephone Number	:	586-286-8720
Fax Number	:	586-286-8723

Provider Business Practice Location Address
First Line	:	361 N CANTON CENTER RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-5096
Country	:	US
Telephone Number	:	734-495-1506
Fax Number	:	734-495-1780

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	03/04/2024

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Directions to “ DR. ALI A BERRY MD” Practice Location

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