Provider Demographics
NPI:1972552560
Name:VORNBERGER, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:VORNBERGER
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 1:21099 MASONIC BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1045
Mailing Address - Country:US
Mailing Address - Phone:586-296-6213
Mailing Address - Fax:586-296-8180
Practice Address - Street 1:21099 MASONIC BLVD
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1045
Practice Address - Country:US
Practice Address - Phone:586-226-6213
Practice Address - Fax:586-226-8180
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08-0501322-2OtherBCBS PIN
MI4471933Medicaid
MI700E0117730OtherBCBS GROUP NUMBER
MICG4684OtherRAILROAD GROUP PTAN
MIP00187766OtherRAILROAD MEDICARE PTAN
MI700E0117730OtherBCBS GROUP NUMBER
MIP00187766OtherRAILROAD MEDICARE PTAN
MIN40170088Medicare PIN