Healthcare Provider Details

I. General information

NPI: 1811981491
Provider Name (Legal Business Name): SETH STAMBERGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 W CLARK RD SUITE 401
YPSILANTI MI
48197-1120
US

IV. Provider business mailing address

3145 W CLARK RD SUITE 401
YPSILANTI MI
48197-1120
US

V. Phone/Fax

Practice location:
  • Phone: 734-528-5700
  • Fax: 734-528-5703
Mailing address:
  • Phone: 734-528-5790
  • Fax: 734-528-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301082696
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: