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Individual
MICHAEL RICHARD BERRY
Active
Individual
MICHAEL RICHARD BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036127202
IL
207X00000X
Orthopaedic Surgery Physician
39450
IA
207XS0117X
Orthopaedic Surgery of the Spine Physician
036127202
IL
207XS0117X
Orthopaedic Surgery of the Spine Physician
39450
IA
390200000X
Student in an Organized Health Care Education/Training Program
2006020074
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209395016
MEDICARE PTAN
IL
01
—
578210011
MEDICARE PTAN
IA
Enumeration date
06/14/2007
Last updated
08/15/2011
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