Individual
DR. ELLIS R. BERKOWITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.02
Contact information
Practice address
5514 CORPORATE DR STE 120, SAINT JOSEPH, MO 64507-7754
(816) 271-1350
(816) 271-1355
Mailing address
5514 CORPORATE DR STE 120, SAINT JOSEPH, MO 64507-7754
(816) 271-1350
(816) 271-1355
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R8874
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100312810A
—
KS
01
—
110045416
RR MEDICARE
MO
05
—
209319003
—
MO
Enumeration date
07/03/2006
Last updated
12/09/2020
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