Provider Demographics
NPI:1497071542
Name:HERRMANN, ANTHONY ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ALBERT
Last Name:HERRMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:ALBERT
Other - Last Name:HERRMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3430 MICHIGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-3824
Mailing Address - Country:US
Mailing Address - Phone:262-498-3080
Mailing Address - Fax:815-642-8385
Practice Address - Street 1:3430 MICHIGAN BLVD
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-3824
Practice Address - Country:US
Practice Address - Phone:262-498-3080
Practice Address - Fax:815-642-8385
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14058-202083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine