Provider Demographics
NPI:1265987390
Name:HERTH, ADAM DOUGLAS (PA-C)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:DOUGLAS
Last Name:HERTH
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9880 ANGIES WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2851
Practice Address - Country:US
Practice Address - Phone:502-394-6341
Practice Address - Fax:502-394-6340
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2021-01-19
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Provider Licenses
StateLicense IDTaxonomies
KYAPPLIED363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant