Provider Demographics
NPI:1093907834
Name:AVERBACH, DAVID HAROLD (MD, MSIA)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HAROLD
Last Name:AVERBACH
Suffix:
Gender:M
Credentials:MD, MSIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 252742
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325
Mailing Address - Country:US
Mailing Address - Phone:248-766-7080
Mailing Address - Fax:509-471-7399
Practice Address - Street 1:1928 TRANQUIL COURT
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390
Practice Address - Country:US
Practice Address - Phone:248-766-7080
Practice Address - Fax:509-471-7399
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME964322084P0804X
CO443612084P0804X
MI43010754372084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G60868Medicare UPIN