Provider Demographics
NPI:1275923567
Name:HERMAN, AUSTIN
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:HERMAN
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 1:552 BEACON LAKE DR
Mailing Address - Street 2:APT 8
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:552 BEACON LAKE DR
Practice Address - Street 2:APT 8
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1968
Practice Address - Country:US
Practice Address - Phone:269-986-5019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2000022987OtherSPECIALIST/TECHNOLOGIST/ATHLETIC TRAINER