Provider Demographics
NPI:1093320442
Name:BERRY, RACHEL JOANNA (MS, PA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JOANNA
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 E MAPLEHURST ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1349
Mailing Address - Country:US
Mailing Address - Phone:419-304-1879
Mailing Address - Fax:248-581-8839
Practice Address - Street 1:4420 E DAVISON ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-1744
Practice Address - Country:US
Practice Address - Phone:313-369-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-12
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010177TMP20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine