Provider Demographics
NPI:1275514044
Name:SANDBERG, HERSHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:HERSHEL
Middle Name:
Last Name:SANDBERG
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 1:750 STEPHENSON HWY
Mailing Address - Street 2:BEAUMONT PAYOR CONTRACT SERVICES
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1103
Mailing Address - Country:US
Mailing Address - Phone:248-577-3511
Mailing Address - Fax:248-577-3526
Practice Address - Street 1:29355 NORTHWESTERN HWY STE 302
Practice Address - Street 2:BEAUMONT OAKLAND COUNTY INTERNISTS
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1053
Practice Address - Country:US
Practice Address - Phone:248-356-7726
Practice Address - Fax:248-356-7749
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301020910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F37698OtherBCBSM
MI0F37698Medicare PIN
B45082Medicare UPIN
MI0F37128022Medicare PIN