Provider Demographics
NPI:1902974090
Name:BERLIN, KEVIN J (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:BERLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1640 FORT ST
Mailing Address - Street 2:SUITE D ATTN DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2040
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:23050 WEST ROAD
Practice Address - Street 2:STE 120
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1470
Practice Address - Country:US
Practice Address - Phone:734-671-1510
Practice Address - Fax:734-671-1570
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2017-02-21
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Provider Licenses
StateLicense IDTaxonomies
MI5101011297207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI343818411Medicaid
MI0H27585OtherBLUE CROSS
MI0H27585OtherBLUE CROSS
MI343818411Medicaid