Provider Demographics
NPI:1629038526
Name:ROSENBERG, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ROSENBERG
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 1:39475 LEWIS DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2977
Mailing Address - Country:US
Mailing Address - Phone:248-374-0502
Mailing Address - Fax:248-374-0567
Practice Address - Street 1:39475 LEWIS DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2977
Practice Address - Country:US
Practice Address - Phone:248-374-0502
Practice Address - Fax:248-374-0567
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067703208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4640858Medicaid
MI0F37698272Medicare ID - Type Unspecified
H20715Medicare UPIN