Individual
DR. GARY L BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
27483 DEQUINDRE RD, SUITE 210, MADISON HEIGHTS, MI 48071-3491
(248) 398-4081
(248) 398-4527
Mailing address
29992 NORTHWESTERN HWY STE C, FARMINGTON HILLS, MI 48334-3292
(248) 851-1430
(248) 851-5182
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
5101008535
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083698997
—
MI
01
—
290003024
RR MEDICARE
MI
01
—
5630250
BCBS INDIVIDUAL
MI
01
—
B46457
HAP
MI
Enumeration date
12/05/2005
Last updated
12/11/2018
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