Provider Demographics
NPI:1417062761
Name:STROMBERG, REID S (MD)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:S
Last Name:STROMBERG
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 1:1943 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1519
Mailing Address - Country:US
Mailing Address - Phone:810-985-5700
Mailing Address - Fax:810-985-5454
Practice Address - Street 1:1943 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1519
Practice Address - Country:US
Practice Address - Phone:810-985-5700
Practice Address - Fax:810-985-5454
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS074708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI34596OtherHEALTH PLAN OF MICHIGAN
MIP00269438OtherMEDICARE TRAVELERS RR
MI0807410702OtherBLUE CROSS/BLUE SHIELD
MI7615621OtherAETNA PPO
MI4643537Medicaid
MI7615621OtherAETNA PPO
MI0807410702OtherBLUE CROSS/BLUE SHIELD