Provider Demographics
NPI:1861475105
Name:HERMAN, KRISTEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:A
Last Name:HERMAN
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 1:15125 22 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4406
Mailing Address - Country:US
Mailing Address - Phone:586-532-0599
Mailing Address - Fax:586-566-8967
Practice Address - Street 1:75 BARCLAY CIR
Practice Address - Street 2:STE 115
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5820
Practice Address - Country:US
Practice Address - Phone:248-856-6300
Practice Address - Fax:248-856-6303
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074131208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION50260Medicare UPIN
H61125Medicare UPIN