Provider Demographics
NPI:1154356574
Name:BERRY, ANDREW HENRY (DO PC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:HENRY
Last Name:BERRY
Suffix:
Gender:M
Credentials:DO PC
Other - Prefix:
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Mailing Address - Street 1:522 W COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3923
Mailing Address - Country:US
Mailing Address - Phone:248-363-7123
Mailing Address - Fax:248-363-5890
Practice Address - Street 1:522 W COMMERCE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-3923
Practice Address - Country:US
Practice Address - Phone:248-363-7123
Practice Address - Fax:248-363-5890
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAB004123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000001040OtherCAPE MEDICAL
5707266OtherAETNA
E25466OtherHAP
104752OtherGREAT LAKES HEALTH PLAN
106153OtherCARE CHOICES
1078OtherMIDWEST HEALTH PLAN
1181OtherTOTAL HEALTH CARE
16964301OtherUNITED HEALTH CARE
5630142OtherBLUE CROSS BLUE SHIELD
38617261OtherHUMANA HEALTH CARE
38617261OtherTRICARE
0856301OtherHEALTH PLUS
5630142OtherBLUE CARE NETWORK
5630142OtherBLUE CROSS BLUE SHIELD
E25466OtherHAP