Provider Demographics
NPI:1730176801
Name:SANDBERG, MICHAEL R (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 EVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2385
Mailing Address - Country:US
Mailing Address - Phone:617-889-2662
Mailing Address - Fax:617-889-1964
Practice Address - Street 1:111 EVERETT AVE
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2385
Practice Address - Country:US
Practice Address - Phone:617-889-2662
Practice Address - Fax:617-889-1964
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA38979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine