Individual
DR. MICAH AVNER BERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 UNIVERSITY AVE E, SAINT PAUL, MN 55101-2507
(651) 291-2848
(651) 602-6885
Mailing address
200 UNIVERSITY AVE E, SAINT PAUL, MN 55101-2507
(651) 291-2848
(651) 602-6885
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
59658
MN
207YP0228X
Pediatric Otolaryngology Physician
59658
MN
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
59658
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H400252166
MEDICARE PTAN
MN
Enumeration date
04/23/2009
Last updated
10/22/2018
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