Provider Demographics
NPI:1174543292
Name:BERKOWITZ, CARY E (MD)
Entity type:Individual
Prefix:
First Name:CARY
Middle Name:E
Last Name:BERKOWITZ
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:W 3985 COUNTY ROAD NN
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-3604
Mailing Address - Country:US
Mailing Address - Phone:262-741-2380
Mailing Address - Fax:262-741-2175
Practice Address - Street 1:W 3985 COUNTY ROAD NN
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-3604
Practice Address - Country:US
Practice Address - Phone:262-741-2380
Practice Address - Fax:262-741-2175
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47361207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04915267OtherBLUE CROSS BLUE SHIELD
IL36047466Medicaid
IL777210Medicare ID - Type UnspecifiedLOCALITY 15
IL36047466Medicaid
IL04915267OtherBLUE CROSS BLUE SHIELD
IL234170Medicare ID - Type UnspecifiedLOCALITY 16