Provider Demographics
NPI:1750348975
Name:HERRING, GERALD (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:HERRING
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 1:7917 MACKINAW TRL
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-9746
Mailing Address - Country:US
Mailing Address - Phone:231-779-9700
Mailing Address - Fax:231-775-9765
Practice Address - Street 1:7917 MACKINAW TRL
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-9746
Practice Address - Country:US
Practice Address - Phone:231-779-9700
Practice Address - Fax:231-779-9765
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301405034208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3314982Medicaid
MI0838932OtherBLUE CROSS BLUE SHIELD
MI0M37180Medicare ID - Type Unspecified
MIF00485Medicare UPIN