Provider Demographics
NPI:1639602477
Name:HERRMANN, ALYSSA S (MD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:S
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:352 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3421
Mailing Address - Country:US
Mailing Address - Phone:716-982-3606
Mailing Address - Fax:
Practice Address - Street 1:29751 LITTLE MACK AVE STE B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-6504
Practice Address - Country:US
Practice Address - Phone:586-415-6200
Practice Address - Fax:586-475-6217
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-08
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301503824207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology