MEDICARE: DR. JAY H SANDBERG D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	5101009208	MI

General Provider Information

NPI Number	:	1548293483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY H SANDBERG D.O

Provider Business Mailing Address
First Line	:	115 E LONG LAKE RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-5524
Country	:	US
Telephone Number	:	248-828-7500
Fax Number	:	248-813-6511

Provider Business Practice Location Address
First Line	:	115 E LONG LAKE RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-5524
Country	:	US
Telephone Number	:	248-828-7500
Fax Number	:	248-813-6511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	09/15/2008

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