Provider Demographics
NPI:1871588749
Name:BERK, DANNY P (MD)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:P
Last Name:BERK
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 1:2200 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3165
Mailing Address - Country:US
Mailing Address - Phone:321-253-2900
Mailing Address - Fax:321-435-0100
Practice Address - Street 1:8057 SPYGLASS HILL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8565
Practice Address - Country:US
Practice Address - Phone:321-241-4877
Practice Address - Fax:321-241-4879
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD-000Medicare UPIN