Healthcare Provider Details

I. General information

NPI: 1003811092
Provider Name (Legal Business Name): LEE MICHAEL STERENBERG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PARK AVE
GRAND HAVEN MI
49417-2173
US

IV. Provider business mailing address

600 PARK AVE
GRAND HAVEN MI
49417-2173
US

V. Phone/Fax

Practice location:
  • Phone: 616-847-8700
  • Fax: 616-847-1049
Mailing address:
  • Phone: 616-847-8700
  • Fax: 616-847-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101009998
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: