Provider Demographics
NPI:1033963129
Name:HERRMANN, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:HERRMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12607 RUSCH RD
Mailing Address - Street 2:
Mailing Address - City:VALDERS
Mailing Address - State:WI
Mailing Address - Zip Code:54245-9612
Mailing Address - Country:US
Mailing Address - Phone:920-242-3488
Mailing Address - Fax:
Practice Address - Street 1:707 QUAY ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4539
Practice Address - Country:US
Practice Address - Phone:920-242-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist