Provider Demographics
NPI:1902628647
Name:BERLIN, WILFRED BRUCE (BS)
Entity type:Individual
Prefix:MR
First Name:WILFRED
Middle Name:BRUCE
Last Name:BERLIN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2805 W ATLANTA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-0947
Mailing Address - Country:US
Mailing Address - Phone:918-638-8302
Mailing Address - Fax:
Practice Address - Street 1:6216 S LEWIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1075
Practice Address - Country:US
Practice Address - Phone:918-960-7852
Practice Address - Fax:539-664-5738
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator