Individual
DR. ENNIS BERKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1008 MERLIN WAY, DEXTER, MI 48130-9834
(269) 217-2992
(734) 623-0108
Mailing address
1008 MERLIN WAY, DEXTER, MI 48130-9834
(269) 217-2992
(734) 623-0108
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
6301 006050
MI
103G00000X
Clinical Neuropsychologist
Primary
6301006050
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C 94573
BLUE CROSS
MI
Enumeration date
09/28/2006
Last updated
03/17/2018
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