Organization
WALLACE P BERKOWITZ MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALLACE P BERKOWITZ MD (PRESIDENT OWNER)
(314) 647-8895
Entity
Organization
Contact information
Practice address
6651 CHIPPEWA, STE 324, ST LOUIS, MO 63109-2538
(314) 647-8895
(314) 647-8898
Mailing address
6651 CHIPPEWA, STE 324, ST LOUIS, MO 63109-2538
(314) 647-8895
(314) 647-8898
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
R4234
MO
207Y00000X
Otolaryngology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08200436
BCBS OF IL
IL
01
—
100287
HEALTHPARTNERS
—
01
—
1007077
UHC
—
01
—
119451
HEALTHLINK
—
01
—
2230168
AETNA HMO
—
01
—
4376271
AETNA PPO
—
01
—
6670
ALLIANCE ALL CHOICE BASIC
MO
01
—
6670
BLUE CHOICE
—
01
—
M2229
MO MCR SUBMITTER ID
MO
01
—
R4234
MO LICENSE NUMBER
MO
Enumeration date
12/15/2005
Last updated
04/20/2008
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