Berkley Medical Centers PC
Organization Active NPI Clinic/Center · Berkley, MI
NPI 1801136395 · NPPES record last updated Nov 18, 2020
Key facts
- NPI
- 1801136395
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- BERKLEY MEDICAL CENTERS PC
- Practice address
- 3345 Coolidge Hwy
Berkley, MI 48072-1635 - Phone
- (248) 544-7110
- NPI assigned
- Feb 21, 2013
- Organization subpart
- No
Authorized official
- Name
- Vian Misho, MD
- Title
- Provider
- Phone
- (248) 544-7110
Practitioners 1
-
Vian Misho, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2059435 | Berkley Medical Centers | Certificate of waiver | May 22, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130621000449 | MI | Part B Supplier - Clinic/Group Practice | 8426297540 |
Receives reassigned benefits from 1 practitioner Practice locations: Berkley, MI |
National Provider Directory
Locations
3345 Coolidge Hwy
Berkley, MI 48072
Phone (248) 544-7110
Interoperability endpoints
- vmisho21516@direct.beaumont.edu
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
3345 Coolidge Hwy
Berkley, MI 48072-1635
Mailing address
3345 Coolidge Hwy
Berkley, MI 48072-1635
Phone (248) 544-7110
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | vmisho21516@direct.beaumont.edu |
Other providers in Berkley, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.