Basic Information
| Provider Information | |||||||||
| NPI: | 1285040436 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERK NEUROSURGICAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6485 SW BORLAND RD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | TUALATIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034825671 | ||||||||
| FaxNumber: | 5034825764 | ||||||||
| Practice Location | |||||||||
| Address1: | 6485 SW BORLAND RD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | TUALATIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034825671 | ||||||||
| FaxNumber: | 5034825764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2014 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | BERK | ||||||||
| AuthorizedOfficialFirstName: | MEHMET | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5034825671 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.