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NPI Code Detail

MEDICARE: MR. GARY M BERKE MS, CP

MEDICARE:  MR. GARY M BERKE  MS, CP
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
1222Z00000XOrthotistCP1628
2224P00000XProsthetistCP1628

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1XB0016280OTHERCAMEDICAL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669490777
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GARY M BERKE MS, CP
Provider Business Mailing Address
First Line : 2001 WINWARD WAY
Second Line : SUITE 100
City : SAN MATEO
State : CA
Zip : 94404-2499
Country : US
Telephone Number : 650-365-5861
Fax Number : 650-365-5896
Provider Business Practice Location Address
First Line : 2001 WINWARD WAY
Second Line : SUITE 100
City : SAN MATEO
State : CA
Zip : 94404-2499
Country : US
Telephone Number : 650-365-5861
Fax Number : 650-365-5896
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 07/21/2022

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Directions to “ MR. GARY M BERKE MS, CP” Practice Location

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