Provider Demographics
NPI:1982651626
Name:HERU, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:HERU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:594 GREAT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-6810
Mailing Address - Country:US
Mailing Address - Phone:401-597-0088
Mailing Address - Fax:401-597-0077
Practice Address - Street 1:594 GREAT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6810
Practice Address - Country:US
Practice Address - Phone:401-597-0088
Practice Address - Fax:401-597-0077
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2016-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RI8125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7006275Medicaid
7006275Medicare ID - Type Unspecified
RI007008969Medicare ID - Type Unspecified
RI7006275Medicaid