Basic Information
| Provider Information | |||||||||
| NPI: | 1962473637 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ANDERBERG | ||||||||
| FirstName: | ROGER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 COMMONWEALTH BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481051593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347476766 | ||||||||
| FaxNumber: | 7347478605 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 E EISENHOWER PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481085205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349719344 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301049376 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.