Provider Demographics
NPI:1356344121
Name:HERMANN, CHRISTOPHER EMIL (NP-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EMIL
Last Name:HERMANN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6592 N SILVERY LN
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2170
Mailing Address - Country:US
Mailing Address - Phone:313-274-1088
Mailing Address - Fax:
Practice Address - Street 1:6592 N SILVERY LN
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2170
Practice Address - Country:US
Practice Address - Phone:313-316-4236
Practice Address - Fax:313-262-1927
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704128568363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4359479Medicaid
MI4359479Medicaid