Basic Information
| Provider Information | |||||||||
| NPI: | 1053407080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERK | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | LEE | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067433150 | ||||||||
| FaxNumber: | 8067433168 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067433150 | ||||||||
| FaxNumber: | 8067433168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L5634 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | L5634 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 108501102 | 05 | TX | MEDICAID | 047380302 | 05 | TN | MEDICAID | 100018050A | 01 | TX | OKLAHOMA MEDICAID | OTHER | 8M1179 | 01 | TX | HMO BLUE | OTHER | 047380302 | 05 | TX | MEDICAID | BE08F0561 | 01 | TX | BC BS | OTHER | 108501101 | 01 | TX | FIRSTCARE | OTHER | 00075046 | 01 | NM MEDICAID | OTHER |