Provider Demographics
NPI:1366490427
Name:HERBENER, JON C (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:C
Last Name:HERBENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 S HOWELL ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-2069
Mailing Address - Country:US
Mailing Address - Phone:517-437-5385
Mailing Address - Fax:517-439-0945
Practice Address - Street 1:187 S HOWELL ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-2069
Practice Address - Country:US
Practice Address - Phone:517-437-5385
Practice Address - Fax:517-439-0945
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJHO33911173000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered173000000XOther Service ProvidersLegal Medicine
Not Answered174400000XOther Service ProvidersSpecialist