Provider Demographics
NPI:1700134731
Name:NEWBERGER, SHANE NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:NORMAN
Last Name:NEWBERGER
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 1:3597 GRIFFITH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1488
Mailing Address - Country:US
Mailing Address - Phone:248-535-4146
Mailing Address - Fax:
Practice Address - Street 1:3597 GRIFFITH AVE
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1488
Practice Address - Country:US
Practice Address - Phone:248-535-4146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101453208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery