Provider Demographics
NPI:1699984062
Name:BERG, AMANDA LISA (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LISA
Last Name:BERG
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Gender:F
Credentials:MD
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Mailing Address - Street 1:4801 S UNIVERSITY DR
Mailing Address - Street 2:STE 104
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3835
Mailing Address - Country:US
Mailing Address - Phone:305-466-0663
Mailing Address - Fax:305-466-9537
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:SUITE 490
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:305-466-0663
Practice Address - Fax:305-466-9537
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-02-12
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Provider Licenses
StateLicense IDTaxonomies
FLME101078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000492100Medicaid
FL000492100Medicaid