Provider Demographics
NPI:1710182670
Name:BLUMBERG, MICHELE LYNNE (DO)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LYNNE
Last Name:BLUMBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43097 WOODWARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5042
Mailing Address - Country:US
Mailing Address - Phone:248-836-0040
Mailing Address - Fax:
Practice Address - Street 1:43097 WOODWARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48302-5042
Practice Address - Country:US
Practice Address - Phone:248-836-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILLICENSEOther036117350