Provider Demographics
NPI:1316995442
Name:HERR, J.MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:J.MICHAEL
Middle Name:
Last Name:HERR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:M
Other - Last Name:HERR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:45 S MAIN ST STE 212
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2402
Mailing Address - Country:US
Mailing Address - Phone:860-236-2515
Mailing Address - Fax:860-236-2572
Practice Address - Street 1:45 S MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2402
Practice Address - Country:US
Practice Address - Phone:860-236-2515
Practice Address - Fax:860-236-2572
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039908204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
80-0090424OtherFEIN
CTD71717Medicare UPIN
CT010000755Medicare PIN
80-0090424OtherFEIN
CT010000755Medicare PIN
CT080001673Medicare ID - Type Unspecified