Provider Demographics
NPI:1811960693
Name:BERGER, MICHELLE A (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:BERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 DUVAL RD
Mailing Address - Street 2:BLDG 4 STE 205
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:512-997-7750
Mailing Address - Fax:512-997-7747
Practice Address - Street 1:4100 DUVAL RD
Practice Address - Street 2:BLDG 4 STE 205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-997-7750
Practice Address - Fax:512-997-7747
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2520207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00H38HOtherBCBS
TXH38HMedicare ID - Type Unspecified
C13390Medicare UPIN