Provider Demographics
NPI:1033705595
Name:HERMAN, MICHAEL (MS, CCP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MS, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 W WICKLOW CT
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3252
Mailing Address - Country:US
Mailing Address - Phone:605-280-1377
Mailing Address - Fax:
Practice Address - Street 1:1316 W WICKLOW CT
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-3252
Practice Address - Country:US
Practice Address - Phone:605-280-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1000-00596242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2MI00034000OtherNJ LICENSE