Provider Demographics
NPI:1174625313
Name:MICHAEL E HERRMANN MD LTD
Entity type:Organization
Organization Name:MICHAEL E HERRMANN MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-235-8600
Mailing Address - Street 1:SUITE 966
Mailing Address - Street 2:2900 FRANK SCOTT PKWY W
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5000
Mailing Address - Country:US
Mailing Address - Phone:618-235-8600
Mailing Address - Fax:618-235-8869
Practice Address - Street 1:SUITE 966
Practice Address - Street 2:2900 FRANK SCOTT PKWY W
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5000
Practice Address - Country:US
Practice Address - Phone:618-235-8600
Practice Address - Fax:618-235-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL984710Medicare PIN