Provider Demographics
NPI:1962689273
Name:ANN E. HERN, M.D., P.C.
Entity Type:Organization
Organization Name:ANN E. HERN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-362-3500
Mailing Address - Street 1:2221 LIVERNOIS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1603
Mailing Address - Country:US
Mailing Address - Phone:248-362-3500
Mailing Address - Fax:248-362-1941
Practice Address - Street 1:2221 LIVERNOIS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1603
Practice Address - Country:US
Practice Address - Phone:248-362-3500
Practice Address - Fax:248-362-1941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430152754207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI070F319160OtherBLUE CROSS BLUE SHIELD
MI1316910649OtherINDIVIDUAL NPI
MIF28205Medicare UPIN
MIN48440002Medicare PIN