Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 5101022181 | MI |
Y | 2084N0402X | Child Neurologist | 5101022181 | MI |
N | 2084N0600X | Clinical Neurophysiologist | 5101022181 | MI |
NPI | 1053553602 |
---|---|
Provider Name | Dr. Amanda Rose Berger Weber |
First Address | Detroit, MI 48201 |
Second Address | Detroit, MI 48201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2009 |
Last Update Date | 07/09/2016 |