Berg Vascular PC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

4301041478 Issued in MI

Legal business name

BERG VASCULAR PC

Practice address

22101 Moross Rd
Detroit, MI 48236-2148

Phone

(313) 343-4000

NPI assigned

May 27, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Richard Berg, MD

Title

Owner

Phone

(586) 285-5783

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433894400000",
    "number": "1073992715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29519 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811275",
            "telephone_number": "586-270-5100",
            "fax_number": "586-270-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148",
            "telephone_number": "313-343-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERG VASCULAR PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-27",
        "last_updated": "2015-06-10",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-285-5783",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "4301041478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Anne Benz, MD
• Tessa Benziger, LMSW
• Gerold Bepler, MD
• Lisa F. Berard, FNP
• Andrew Berdasono, CRNA
• Berg-Lahser SNF, LLC
• Jamie Berg, LLPC
• Megan F. Berg, RN-BSN, DNP, CRNA
• Richard A. Berg, M.D.
• Megan Berger Cromwell, LMSW

• Vascular Surgery Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Vascular Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.