Provider Demographics
NPI:1962409292
Name:BERGER, JEFFREY PAUL (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:BERGER
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 1:17940 FARMINGTON RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3157
Mailing Address - Country:US
Mailing Address - Phone:734-338-0600
Mailing Address - Fax:734-338-0601
Practice Address - Street 1:17940 FARMINGTON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3157
Practice Address - Country:US
Practice Address - Phone:734-338-0600
Practice Address - Fax:734-338-0601
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041195207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080H215880OtherBCBS & BCN
MI16126OtherM'CARE
MI136737OtherCARE CHOICES
MI147145OtherGREAT LAKES HEALTH PLAN
MI665-2OtherTOTAL HEALTH CARE
MI4036582OtherAETNA
MI4520279Medicaid
MI2135729OtherFIRST HEALTH
MIP00211584OtherRAILROAD MEDICARE
MI4561440Medicaid
MI2135729OtherFIRST HEALTH
MI4561440Medicaid