Provider Demographics
NPI:1316067895
Name:BERRY, HADI (DO)
Entity type:Individual
Prefix:
First Name:HADI
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TURNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1167
Mailing Address - Country:US
Mailing Address - Phone:313-228-5616
Mailing Address - Fax:313-438-6420
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:DETROIT RECEIVING HOSPITAL-GATEWAY TO HEALTH CLINIC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4372
Practice Address - Fax:313-993-3911
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5104OtherMEDICARE ID
MIH16181043Medicare PIN
MIMI5104001Medicare PIN