Provider Demographics
NPI:1821036054
Name:HERRMANN, MARTIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:HERRMANN
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 1:301 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-1709
Mailing Address - Country:US
Mailing Address - Phone:952-758-4431
Mailing Address - Fax:952-758-5011
Practice Address - Street 1:301 2ND ST NE
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-1709
Practice Address - Country:US
Practice Address - Phone:952-758-4431
Practice Address - Fax:507-364-5686
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN911865900Medicaid
MNE95297Medicare UPIN
MN911865900Medicaid