Individual
DR. ANGELA DENA ICEBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
31815 SOUTHFIELD RD STE 12, BEVERLY HILLS, MI 48025
(248) 645-2220
(877) 547-8277
Mailing address
227 COREY LN, ORTONVILLE, MI 48462-9707
(248) 884-4246
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5330000481
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MI1300001
MEDICARE PTAN
MI
Enumeration date
07/24/2006
Last updated
09/20/2018
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