Provider Demographics
NPI:1598765364
Name:HERMAN, PAUL RODNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RODNEY
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:221 RED COACH DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8323
Mailing Address - Country:US
Mailing Address - Phone:574-273-6787
Mailing Address - Fax:574-968-0882
Practice Address - Street 1:710 PARK PL
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3519
Practice Address - Country:US
Practice Address - Phone:574-273-7687
Practice Address - Fax:574-968-0882
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01032678A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN140630EMedicare ID - Type Unspecified
INE03809Medicare UPIN