Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101009998 | MI |
NPI | 1003811092 |
---|---|
Provider Name | Lee Michael Sterenberg |
First Address | Grand Haven, MI 49417-2173 |
Second Address | Grand Haven, MI 49417-2173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 25/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3108080 | (05) | MI |
3192075 | (05) | MA |
5190580 | (05) | MI |
E78150 | (02) |