Berry, Michael Richard
Berry, Michael Richard is an individual health care provider with primary practice located at 520 Valley View Dr , Moline IL 61265-6194. He recently has 3 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Orthopaedic Surgery of the Spine, Allopathic & Osteopathic Physicians / Orthopaedic Surgery. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Berry, Michael Richard can be contacted via phone (309) 762-3621.Contact Information
Primary practice address
520 Valley View Dr
Moline IL 61265-6194
Phone: (309) 762-3621
Fax: (309) 762-3690
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | 2006020074 | Missouri |
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery of the Spine | 207XS0117X | 036127202 | Illinois |
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery of the Spine | 207XS0117X | 39450 | Iowa |
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 036127202 | Illinois |
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 39450 | Iowa |
Profile Details
| NPI number | 1114121969 |
|---|---|
| LBN Legal business name | Berry, Michael Richard |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 14th, 2007 |
| Last updated | Aug 15th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114121969 | NPPES |
| Iowa | Other | 578210011 | MEDICARE PTAN |
| Iowa | Other | 209395016 | MEDICARE PTAN |
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