Provider Demographics
NPI:1750620134
Name:MICHELLE BERMAN MS RD CDE LLC
Entity type:Organization
Organization Name:MICHELLE BERMAN MS RD CDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITION
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDE
Authorized Official - Phone:480-216-1635
Mailing Address - Street 1:PO BOX 1564
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85211-1564
Mailing Address - Country:US
Mailing Address - Phone:480-294-6543
Mailing Address - Fax:480-294-6544
Practice Address - Street 1:1237 S VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6401
Practice Address - Country:US
Practice Address - Phone:480-294-6543
Practice Address - Fax:480-294-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty