Healthcare Provider Details

I. General information

NPI: 1235520024
Provider Name (Legal Business Name): ANNA LEHRBERG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA DYUKAREVA D.O.

II. Dates (important events)

Enumeration Date: 02/14/2015
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BIDDLE AVE
WYANDOTTE MI
48192-4668
US

IV. Provider business mailing address

2333 BIDDLE AVE
WYANDOTTE MI
48192-4668
US

V. Phone/Fax

Practice location:
  • Phone: 734-246-8004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5151012793
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101021511
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101025607
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: