Provider Demographics
NPI:1083611784
Name:ROSENBERG, DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7296 SIMSBURY DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3548
Mailing Address - Country:US
Mailing Address - Phone:248-737-2343
Mailing Address - Fax:248-737-3959
Practice Address - Street 1:7296 SIMSBURY DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3548
Practice Address - Country:US
Practice Address - Phone:248-737-2343
Practice Address - Fax:248-737-3959
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0207213E00000X
MI5901000677213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1080580Medicaid
MI8825444OtherBCBSM
MI4333620001OtherDMERC
MI1080580Medicaid
MIT78250Medicare UPIN