Provider Demographics
NPI:1700573946
Name:HERZOG, KIERSTEN HOPE (MD)
Entity type:Individual
Prefix:DR
First Name:KIERSTEN
Middle Name:HOPE
Last Name:HERZOG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAY
Other - Middle Name:HOPE
Other - Last Name:HERZOG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:550 UNIVERSITY BLVD # 2440
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5149
Mailing Address - Country:US
Mailing Address - Phone:317-948-5923
Mailing Address - Fax:
Practice Address - Street 1:550 UNIVERSITY BLVD # 2440
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-948-5923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program