# MICHAEL RICHARD BERRY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1114121969
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 036127202 | IL | Yes |
| 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

- **Enumeration date:** 06/14/2007
- **Last updated:** 08/15/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 209395016 | MEDICARE PTAN | IL |
| 01 | — | 578210011 | MEDICARE PTAN | IA |