Provider Demographics
NPI:1225014228
Name:BERRY, STEVEN G (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:G
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 NW 114TH ST
Mailing Address - Street 2:STE 347
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7046
Mailing Address - Country:US
Mailing Address - Phone:515-224-1777
Mailing Address - Fax:515-222-0226
Practice Address - Street 1:1601 NW 114TH ST
Practice Address - Street 2:STE 347
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50325-7046
Practice Address - Country:US
Practice Address - Phone:515-224-1777
Practice Address - Fax:515-222-0226
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22473207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA73008OtherCOVENTRY
IA35327OtherMIDLAND'S CHOICE
IA0017129Medicaid
IA25923OtherWELLMARK
IAIA0105OtherUHC OF THE RIVER VALLEY
IA849733OtherUHC
A03608Medicare UPIN
IAIA0105OtherUHC OF THE RIVER VALLEY