Provider Demographics
NPI:1982629051
Name:HERRMANN, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
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 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:
Practice Address - Street 1:311 W. FAIRCHILD STREET
Practice Address - Street 2:PSYCHIATRY/PSYCHOLOGY
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3874
Practice Address - Country:US
Practice Address - Phone:217-431-7898
Practice Address - Fax:217-431-7634
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360559912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C75810Medicare UPIN
ILC75810Medicare UPIN
IL6447860014Medicare NSC
ILIL3270057Medicare PIN