Provider Demographics
NPI:1427057728
Name:BERKSON, MICHAEL H (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:BERKSON
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 1:530 PARK AVE E
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356
Mailing Address - Country:US
Mailing Address - Phone:815-875-2811
Mailing Address - Fax:
Practice Address - Street 1:530 PARK AVE E STE 306
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-3903
Practice Address - Country:US
Practice Address - Phone:815-876-3099
Practice Address - Fax:815-876-3003
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-052590207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052590Medicaid
0451517835OtherBLUE SHIELD
791203314OtherRR MEDICARE
200008160OtherRR MEDICARE
791203314OtherRR MEDICARE
200008160OtherRR MEDICARE
569600Medicare ID - Type Unspecified
IL5413370001Medicare NSC