Provider Demographics
NPI:1386064939
Name:SANDBERG, JASON MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20952 E 12 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3203
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-6620
Practice Address - Street 1:130 TOWN CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-1744
Practice Address - Country:US
Practice Address - Phone:248-740-0670
Practice Address - Fax:248-740-1668
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2020-10-14
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Provider Licenses
StateLicense IDTaxonomies
MI4301501364208800000X
IAMD-45828208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology