Provider Demographics
NPI:1700853447
Name:LUMBERG, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:LUMBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4600 INVESTMENT DR
Mailing Address - Street 2:STE 300
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098
Mailing Address - Country:US
Mailing Address - Phone:248-267-5000
Mailing Address - Fax:248-267-5001
Practice Address - Street 1:4600 INVESTMENT DR
Practice Address - Street 2:STE 300
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098
Practice Address - Country:US
Practice Address - Phone:248-267-5000
Practice Address - Fax:248-267-5001
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301070419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIW95808Medicare UPIN
MIM07130021Medicare PIN