Provider Demographics
NPI:1053553602
Name:WEBER, AMANDA ROSE BERGER (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ROSE BERGER
Last Name:WEBER
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:4201 ST. ANTOINE UHC 5D MAILBOX# 226
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-5051
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3901 BEAUBIEN
Practice Address - Street 2:CHILDREN'S HOSPITAL OF MICHIGAN
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5788
Practice Address - Fax:313-745-5074
Is Sole Proprietor?:No
Enumeration Date:2009-03-28
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101022181208000000X, 2084N0600X, 2084N0402X
OH34.010067208000000X, 2084N0402X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0124463Medicaid