Individual
MR. SAMUEL BERRY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6085 COVERED WAGONS TRL, FLINT, MI 48532-2100
(248) 259-2929
(810) 407-7139
Mailing address
6085 COVERED WAGONS TRL, FLINT, MI 48532-2100
(248) 259-2929
(810) 407-7139
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B600758013681
TRANSPORTATION PROVIDER
MI
Enumeration date
04/05/2022
Last updated
04/05/2022
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