Provider Demographics
NPI:1174584528
Name:BERKOW, ANDREW E (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:E
Last Name:BERKOW
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 1:1970 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2710
Mailing Address - Country:US
Mailing Address - Phone:563-359-3949
Mailing Address - Fax:
Practice Address - Street 1:1970 E 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2710
Practice Address - Country:US
Practice Address - Phone:563-359-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA212112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6176404Medicaid
17640OtherBCBS OF IOWA WITH RGIC LL
IA20790OtherBCBS OF IOWA W/ ORA
300132305OtherRAILROAD MEDICARE RGIC LL
IA1176404Medicaid
IA20790OtherMEDICARE W/ ORA
IA3176404OtherMEDICAID W/ ORA
300016598OtherRAILROAD MEDICARE RG PC
30010OtherBCBS OF IOWA / WITH RG PC
IA300125723OtherRAILROAD MEDICARE W/ ORA
IAK51232OtherMEDICARE - ORA ILLINOIS
17640OtherBCBS OF IOWA WITH RGIC LL
30010OtherBCBS OF IOWA / WITH RG PC
IA300125723OtherRAILROAD MEDICARE W/ ORA