Individual
HADI BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
4201 SAINT ANTOINE ST, DETROIT RECEIVING HOSPITAL-GATEWAY TO HEALTH CLINIC, DETROIT, MI 48201-2153
(313) 745-4372
(313) 993-3911
Mailing address
14 TURNBERRY LN, DEARBORN, MI 48120-1167
(313) 228-5616
(313) 438-6420
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101016963
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MI5104
MEDICARE ID
MI
Enumeration date
03/30/2007
Last updated
10/03/2016
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