Provider Demographics
NPI:1942432349
Name:EDWARD L. HERMAN MD PC
Entity Type:Organization
Organization Name:EDWARD L. HERMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-338-2497
Mailing Address - Street 1:43996 WOODWARD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5027
Mailing Address - Country:US
Mailing Address - Phone:248-338-2497
Mailing Address - Fax:248-332-4552
Practice Address - Street 1:43996 WOODWARD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5027
Practice Address - Country:US
Practice Address - Phone:248-338-2497
Practice Address - Fax:248-332-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010240952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1066544-10Medicaid
MI1066544-10Medicaid
0633879Medicare PIN