Provider Demographics
NPI:1063480051
Name:GREENBERG, CHARLES H (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 BIG BEAVER RD
Mailing Address - Street 2:STE 105
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-649-2820
Mailing Address - Fax:248-649-1444
Practice Address - Street 1:3001 BIG BEAVER RD
Practice Address - Street 2:STE 105
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-649-2820
Practice Address - Fax:248-649-1444
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031150207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376547Medicaid
MIB44973OtherMEDICARE RAILROAD
MI1806356171OtherBLUE CROSS BLUE SHIELD
MI1376547Medicaid
MI1806356171OtherBLUE CROSS BLUE SHIELD