BERG VASCULAR PC (NPI# 1073992715) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073992715 |
| Entity Type | Organization |
| Organization Name | BERG VASCULAR PC |
| Practice Address |
22101 Moross Rd Detroit MI 48236-2148 |
| Mailing Address |
29519 Harper Ave Saint Clair Shores MI 48081-1275 |
| Practice Telephone | 3133434000 |
| Mailing Telephone | 5862705100 |
| Mailing Fax Number | 5862705111 |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-06-10 |
| Authorized Official Name | RICHARD BERG (OWNER) |
| Authorized Official Telephone | 5862855783 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
4301041478 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
22101 MOROSS RD |
| City | DETROIT |
| State | MI |
| Zip Code | 48236-2148 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083609887 | Anne M Schneider | Obstetrics & Gynecology | 22101 Moross Rd, 313, Detroit, MI 48236-2148 | 2005-09-19 |
| 1346848827 | Tanya L Locke | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-10-15 |
| 1588261556 | Ryan Guthrie | Student in an Organized Health Care Education/Training Program | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-10-02 |
| 1578160743 | Lauren Kudirka | Speech-Language Pathologist | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-10-01 |
| 1952918740 | Lisa Colombo | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-09-26 |
| 1124635917 | Gjergj George Juncaj | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-09-26 |
| 1194337881 | Lori Holaly | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-08-23 |
| 1548870066 | Tamara Siblini | Student in an Organized Health Care Education/Training Program | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-08-10 |
| 1104436583 | David Mark Thomas | Student in an Organized Health Care Education/Training Program | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-07-31 |
| 1780293969 | Alexander Swend Mortensen | Student in an Organized Health Care Education/Training Program | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-07-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093323966 | Khairya Fatouh | Pathology | 22101 Morros Road, Pathology Department, Detroit, Detroit, MI 48236 | 2020-07-16 |
| 1134744998 | Harish Harry Gidda | Internal Medicine | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-08 |
| 1770107443 | Arshan Ali Khan | Internal Medicine | 22101 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-05-29 |
| 1750901658 | Annika Van Wieren | Emergency Medicine | 22101 Moross Road, Emergency Department, Detroit, MI 48236 | 2020-04-21 |
| 1801449483 | Ishaq Azeem Asghar | Student in an Organized Health Care Education/Training Program | 22101 Moross Road, Pathology Department, Detroit, MI 48236 | 2019-07-22 |
| 1295290443 | Ascension St. John Hospital | Dietitian, Registered | 22201 Moross, Ste. 270, Detriot, MI 48236 | 2019-02-01 |
| 1548747413 | Abiodun Adenuga Adefarasin | Pharmacist | 20746 Mack Avenue, Gross Pointe Woods, MI 48236 | 2018-07-24 |
| 1629564042 | Hamza H Khan | Student in an Organized Health Care Education/Training Program | 22201 Moross, Professional Building 2, Suite 70, Detroit, MI 48236 | 2018-07-09 |
| 1235631664 | David Lee Williams | Physical Therapist | 159 Kercheval Avenue, Grosse Pointe Farms, MI 48236 | 2018-03-01 |
| 1164979720 | Memphie Morgan | Licensed Practical Nurse | 91527 Cheshire St., Grosse Pointe, MI 48236 | 2016-09-01 |
| Find all providers in zip 48236 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437383197 | Barbara D'agnoluzzo Moreira | Surgery | 3663 Woodward Ave Ste 200, Wsu Detroit Medical Center, Detroit, MI 48201-2400 | 2009-05-11 |
| 1083822753 | Yevgeniy Rits | Surgery | 4160 John R #615, Harper Professional Bldg, Detroit, MI 48201-2065 | 2007-05-18 |
| 1740299858 | Paul J. Corcoran | Surgery | 2799 W Grand Blvd # K8, Detroit, MI 48202-2608 | 2006-08-07 |
| 1215343553 | Frederick John Jaecklein | Surgery | 4201 Saint Antoine St, 9cuhc, Detroit, MI 48201-2153 | 2014-07-08 |
| 1689091878 | Melanie Schwiesow | Surgery | 311 Mack Ave Ste 64100, Detroit, MI 48201 | 2014-03-25 |
| 1912347279 | Andi Peshkepija | Surgery | 2799 W Grand Blvd # K8, Detroit, MI 48202-2608 | 2013-07-01 |
| 1992915813 | Stavros Kakkos | Surgery | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2007-05-22 |
| 1518171420 | John W. Sealey, D.o., P.C. | Surgery | 6001 W Outer Dr, Suite 445, Detroit, MI 48235-2614 | 2007-05-09 |
| 1801951637 | Hisham S Bassiouny | Surgery | 2799 W Grand Blvd, Detroit, MI 48202 | 2006-12-22 |
| 1114080744 | Alexander D. Shepard | Surgery | Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202 | 2006-12-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.