Provider Demographics
NPI:1962487041
Name:ROSENBERG, DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30840 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2552
Mailing Address - Country:US
Mailing Address - Phone:248-932-8725
Mailing Address - Fax:248-932-8977
Practice Address - Street 1:30840 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2552
Practice Address - Country:US
Practice Address - Phone:248-932-8725
Practice Address - Fax:248-932-8977
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1962487041Medicaid
MI700F319250OtherMI BLUE SHIELD
MI0N92860Medicare PIN
MI0N53930008Medicare PIN
MIE33236Medicare UPIN