Organization
COMPREHENSIVE NEUROPSYCHOLOGICAL SERVICES PC
Active
Organization
COMPREHENSIVE NEUROPSYCHOLOGICAL SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ENNIS BERKER (PRESIDENT)
(269) 217-2992
Entity
Organization
Contact information
Practice address
7320 GARDEN LN, PORTAGE, MI 49002-4423
(269) 217-2992
(269) 324-7707
Mailing address
7320 GARDEN LN, PORTAGE, MI 49002-4423
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
6301006050
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0M0-9810
MEDICARE PART B
MI
01
—
680C945730
BLUE CROSS
MI
Enumeration date
05/07/2012
Last updated
05/07/2012
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